Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11015557 | FL |
NPI | 1063184539 |
---|---|
Provider Name | Jennifer Lynne Stufflebeam |
First Address | Naples, FL 34110-9200 |
Second Address | Naples, FL 34110-9200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 01/10/2021 |