Provider Demographics
NPI:1225844921
Name:DREW, JEREMY A (RN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:DREW
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HERALDO CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3351
Mailing Address - Country:US
Mailing Address - Phone:646-250-6908
Mailing Address - Fax:
Practice Address - Street 1:626 HERALDO CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3351
Practice Address - Country:US
Practice Address - Phone:646-250-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9596378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse