Provider Demographics
NPI:1699294496
Name:TRAVERSO, JENNIFER DEMAISIP (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DEMAISIP
Last Name:TRAVERSO
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 1:4667 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4086
Mailing Address - Country:US
Mailing Address - Phone:386-281-7978
Mailing Address - Fax:
Practice Address - Street 1:735 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9226
Practice Address - Country:US
Practice Address - Phone:888-808-0488
Practice Address - Fax:386-872-4232
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3416832363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner