1285653790 NPI number — MS. JENNIFER SEALE ARNP

Table of content: MS. JENNIFER SEALE ARNP (NPI 1285653790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285653790 NPI number — MS. JENNIFER SEALE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEALE
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285653790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33733-2868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-532-0002
Provider Business Mailing Address Fax Number:
727-266-4943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 10TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33705-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-824-8274
Provider Business Practice Location Address Fax Number:
727-824-8293
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00131613 . This is a "RR MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 305636800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012370300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104830600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".