Provider Demographics
NPI:1386238004
Name:COURSON, JENNIFER MICHELE (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:COURSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9580 APPLECROSS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5843
Mailing Address - Country:US
Mailing Address - Phone:904-778-9180
Mailing Address - Fax:904-778-9740
Practice Address - Street 1:9580 APPLECROSS RD STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-5843
Practice Address - Country:US
Practice Address - Phone:904-778-9180
Practice Address - Fax:904-778-9740
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner