Provider Demographics
NPI:1174251490
Name:PUGH, JENNIFER LYNSEY (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNSEY
Last Name:PUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 NEVEAH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7201
Mailing Address - Country:US
Mailing Address - Phone:443-629-1952
Mailing Address - Fax:
Practice Address - Street 1:1400 ROCKLEDGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2846
Practice Address - Country:US
Practice Address - Phone:321-735-8960
Practice Address - Fax:321-735-8964
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07221776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine