Provider Demographics
NPI:1891520458
Name:MOSQUERA MEJIAS, JENNY (FNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MOSQUERA MEJIAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 OAK CREEK CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6591
Mailing Address - Country:US
Mailing Address - Phone:786-326-6830
Mailing Address - Fax:
Practice Address - Street 1:3411 W TAMPA BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6619
Practice Address - Country:US
Practice Address - Phone:813-466-4678
Practice Address - Fax:813-616-6280
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07240836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily