Provider Demographics
NPI:1295709475
Name:CROMWELL, JEANNINE (LPN)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:CROMWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9516
Mailing Address - Country:US
Mailing Address - Phone:407-943-8677
Mailing Address - Fax:407-892-6468
Practice Address - Street 1:1050 GRAPE AVE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-943-8677
Practice Address - Fax:407-892-6468
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN695961164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse