Jennifer C Eziefuoh, APRN
Individual provider Active NPI Nurse Practitioner · Bradenton, FL
NPI 1013481787 · NPPES record last updated Jan 16, 2019
Key facts
- NPI
- 1013481787
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN (FL)
- Practice address
- 8610 State Road 70 E
Bradenton, FL 34202-3785 - Phone
- (941) 242-1929
- Fax
- (941) 242-5116
- NPI assigned
- Jan 16, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN | FL | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN | FL | Yes |
Addresses
Primary practice location
8610 State Road 70 E
Bradenton, FL 34202-3785
Mailing address
8610 State Road 70 E
Bradenton, FL 34202-3785
Phone (941) 242-1929
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.