Provider Demographics
NPI:1386424133
Name:WAINWRIGHT, JENNIFER MICHELLE
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 SUMMIT GLN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-1205
Mailing Address - Country:US
Mailing Address - Phone:214-934-3756
Mailing Address - Fax:
Practice Address - Street 1:6305 INITIATIVE BLVD SUITE 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-388-8997
Practice Address - Fax:941-306-5876
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028881363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care