Provider Demographics
NPI:1386152072
Name:ROGERS, JENNIFER LEEANNE (CRNA)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEEANNE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 W NEWBERRY ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-331-8902
Mailing Address - Fax:352-224-1094
Practice Address - Street 1:6400 W NEWBERRY ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-331-8902
Practice Address - Fax:352-224-1094
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9314034367500000X
FLAPRN117535367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9314034Medicaid