Provider Demographics
NPI:1306055017
Name:GERTH, JENNIFER (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:GERTH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7301
Mailing Address - Country:US
Mailing Address - Phone:239-949-6606
Mailing Address - Fax:
Practice Address - Street 1:3301 TAMIAMI TRL E
Practice Address - Street 2:COLLIER GOV'T CENTER-BLDG H
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-3969
Practice Address - Country:US
Practice Address - Phone:239-732-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant