Provider Demographics
NPI:1487994158
Name:VENDT, JENNIFER (ARNP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:VENDT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 FORTUNE PKWY UNIT 402
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6750
Mailing Address - Country:US
Mailing Address - Phone:904-519-0008
Mailing Address - Fax:904-379-7312
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 402
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6750
Practice Address - Country:US
Practice Address - Phone:904-519-0008
Practice Address - Fax:904-379-7312
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9232724363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics