Provider Demographics
NPI:1215622394
Name:ARTUS, JENNIFER OMOLON
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:OMOLON
Last Name:ARTUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24025 MADACA LN UNIT 201
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2813
Mailing Address - Country:US
Mailing Address - Phone:973-641-8985
Mailing Address - Fax:361-900-3465
Practice Address - Street 1:24025 MADACA LN UNIT 201
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2813
Practice Address - Country:US
Practice Address - Phone:973-641-8985
Practice Address - Fax:361-900-3465
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily