Provider Demographics
NPI:1063912392
Name:GREGORY, JENNY JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:JEAN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:JEAN
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3571 COUNTY ROAD 218
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-7211
Mailing Address - Country:US
Mailing Address - Phone:904-504-3034
Mailing Address - Fax:
Practice Address - Street 1:3571 COUNTY ROAD 218
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-7211
Practice Address - Country:US
Practice Address - Phone:904-504-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3398372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily