Provider Demographics
NPI:1922806033
Name:ANDERSON, JENNIFER AMY (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:AMY
Last Name:ANDERSON
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 1:20072 HEATHERSTONE WAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3099
Mailing Address - Country:US
Mailing Address - Phone:716-740-6957
Mailing Address - Fax:
Practice Address - Street 1:20072 HEATHERSTONE WAY UNIT 1
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3099
Practice Address - Country:US
Practice Address - Phone:716-740-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9323208163W00000X
FLAPRN11039705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse