Provider Demographics
NPI:1720477151
Name:POPE, JENNIFER SHEA SANDERS (DNP, CRNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SHEA SANDERS
Last Name:POPE
Suffix:
Gender:F
Credentials:DNP, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18317 US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567
Mailing Address - Country:US
Mailing Address - Phone:251-947-2000
Mailing Address - Fax:
Practice Address - Street 1:18317 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567
Practice Address - Country:US
Practice Address - Phone:251-947-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0RN5OtherBCBS
FLID056ZOtherMEDICARE INDIVIDUAL PROVIDER PTAN
FLK4348OtherMEDICARE GROUP PTAN