Provider Demographics
NPI:1427602820
Name:JENNINGS, INGA (APRN)
Entity type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:JENNINGS
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 1:1482 N. WILSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-323-2136
Mailing Address - Fax:863-656-3401
Practice Address - Street 1:1482 N. WILSON AVENUE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830
Practice Address - Country:US
Practice Address - Phone:863-323-2136
Practice Address - Fax:863-656-3401
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2025-10-08
Deactivation Date:2025-08-19
Deactivation Code:
Reactivation Date:2025-09-11
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003431363L00000X, 2084N0400X, 208VP0014X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily