Provider Demographics
NPI:1316236250
Name:JEMISON, ELEANOR ELIZABETH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:ELIZABETH
Last Name:JEMISON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5303
Mailing Address - Country:US
Mailing Address - Phone:850-932-0036
Mailing Address - Fax:
Practice Address - Street 1:3143 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5303
Practice Address - Country:US
Practice Address - Phone:850-932-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3123872163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse