Jennifer Sue Gravell Mendoza, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP-9238808 Issued in FL

Practice address

2000 Prevatt St
Suite B3
Eustis, FL 32726-6149

Phone

(321) 273-0301

NPI assigned

Apr 19, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jennifer Sue Mendoza Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Florida Facilitists, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Longwood, FL
  • NPI 1043252307
  NPD (past)

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780801159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 JECENIA BLOSSOM DR",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327124437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PREVATT ST",
            "address_2": "SUITE B3",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327266149",
            "telephone_number": "321-273-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAVELL MENDOZA",
        "first_name": "JENNIFER",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP-9238808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITINER LICENSE",
            "identifier": "ARNP-9238808",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC FNP BD CERT",
            "identifier": "2005010729",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MENDOZA",
            "middle_name": "SUE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Katryna Goodman
• Sherryl Gaye Gordon, M.D.
• Natasha Grace
• Christine Lynn Gramaglia, OTR
• Grateful Health LLC
• Laquita Green-Norflee
• Lawrence Ezra Green, M.D.
• Jay Norman Grefe Jr.
• Shatahvia Grier
• Miranda Gue

• Family Nurse Practitioner in Eustis, FL
• Providers in Eustis, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.