Individual provider Active NPI

Jennifer Roberts

  • Family Nurse Practitioner
  • Sun City Center, FL
National Provider Identifier
1720464910
Registry record updated Aug 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9356545 Issued in FL
Practice address
717 Imar Dr
Sun City Center, FL 33573-5368
Phone
(813) 634-3500
NPI assigned
Aug 11, 2015
Last updated
Aug 26, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ARNP9356545 FL Primary

Addresses

Primary practice location

717 Imar Dr
Sun City Center, FL 33573-5368

Mailing address

4511Oak River Circle
Valrico, FL 33596
Phone (352) 222-4163

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160620002051 FL Practitioner - Nurse Practitioner 1850682907 Reassigns benefits to 1 organization
I20201102000993 TN Practitioner - Nurse Practitioner 1850682907

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sunshine Neurology PA CurrentSince Nov 17, 2015 Accepting new patients

Locations

717 Imar Dr
Sun City Ctr, FL 33573
Phone (813) 634-3500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440547200000",
    "number": "1720464910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511OAK RIVER CIRCLE",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "33596",
            "telephone_number": "352-222-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 IMAR DR",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335735368",
            "telephone_number": "813-634-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2015-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9356545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City Center, FL

Sources for this page

Verify at the official NPI Registry.