Jennifer Lynn Waller, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11017307 Issued in FL

Practice address

14502 N Dale Mabry Hwy Ste 200
Tampa, FL 33618-2040

Phone

(800) 640-3451

NPI assigned

Jun 16, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Lynn Waller Professional name

Medicare fee-for-service enrollment

Enrolled in FL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Rmed LLC

  • Internal Medicine Physician
  • Jacksonville, FL
  • NPI 1508815358
  Medicare reassignment NPD
• Harmonycares Complete Health Services, PLLC

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1093543902

  FL

  Medicare reassignment NPD
• Rmed LLC

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1205476793
  NPD
• Hypertension Kidney and Stone Center, LLC

  • Nephrology Physician
  • Zephyrhills, FL
  • NPI 1134679293
  NPD (past)

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

{
    "created_epoch": "1655337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1821728395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 914",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840431189",
            "telephone_number": "800-640-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14502 N DALE MABRY HWY STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182040",
            "telephone_number": "800-640-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-16",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11017307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WALLER",
            "middle_name": "LYNN",
            "credential": "APRN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Yelda N Wallace
• Zandra Wynette Wallace
• Maria Wallen
• Marva Ann Marie Wallen, RN
• Seren Devol Wallen, PA-C
• Kenneth Ray Waller Jr., RBT
• Anthony David Emmanuel Wallitsch, DMD
• Robyn Wallman
• Jean M. Wallner, P.A.-C
• Louise Wallowitz

• Family Nurse Practitioner in Tampa, FL
• Providers in Tampa, 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 Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.