Provider Demographics
NPI:1154986156
Name:MERTIFF, JENNIFER ELLEN (APRN FNP-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:MERTIFF
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-621-0671
Mailing Address - Fax:
Practice Address - Street 1:463646 SR 200
Practice Address - Street 2:SUITE 12
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-2640
Practice Address - Country:US
Practice Address - Phone:904-775-3601
Practice Address - Fax:904-849-1919
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001171363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner