Individual provider Active NPI

Jenny C Jeudi, FNP-BC

  • Family Nurse Practitioner
  • Lake Worth, FL
National Provider Identifier
1619675311
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11024928 Issued in FL
Practice address
3450 Lantana Rd Ste 100
Lake Worth, FL 33462-1304
Phone
(561) 965-1864
NPI assigned
Feb 21, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2022001273 FL
Family Nurse Practitioner 363LF0000X 11024928 FL Primary

Addresses

Primary practice location

3450 Lantana Rd Ste 100
Lake Worth, FL 33462-1304

Mailing address

5416 Sandbirch Way
Lake Worth, FL 33463-7201
Phone (516) 495-0552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11024928FLMDFamily Nurse Practitioner
2022001273FLMDFamily Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677196800000",
    "number": "1619675311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5416 SANDBIRCH WAY",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334637201",
            "telephone_number": "516-495-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LANTANA RD STE 100",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334621304",
            "telephone_number": "561-965-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEUDI",
        "first_name": "JENNY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-21",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "2022001273",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11024928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.