Provider Demographics
NPI:1174386379
Name:GUNDERSON, JESSICA ANN (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 VENETIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7163
Mailing Address - Country:US
Mailing Address - Phone:941-483-5730
Mailing Address - Fax:941-483-5740
Practice Address - Street 1:825 VENETIAN PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7163
Practice Address - Country:US
Practice Address - Phone:941-483-5730
Practice Address - Fax:941-483-5740
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11030821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily