Provider Demographics
NPI:1336743582
Name:TARVIS, JENNIFER A (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:TARVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5757
Mailing Address - Country:US
Mailing Address - Phone:906-369-1251
Mailing Address - Fax:
Practice Address - Street 1:1825 KINGSLEY AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4484
Practice Address - Country:US
Practice Address - Phone:904-264-8621
Practice Address - Fax:904-215-9418
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294673363LF0000X
FL11030849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily