Provider Demographics
NPI:1063308146
Name:BANDIN, JENNIFER VANESSA (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VANESSA
Last Name:BANDIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SW 92ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8146
Mailing Address - Country:US
Mailing Address - Phone:305-970-4007
Mailing Address - Fax:
Practice Address - Street 1:723 TRUMAN AVE # 5040623
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32314-8602
Practice Address - Country:US
Practice Address - Phone:305-501-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9399992163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency