Provider Demographics
NPI:1902058035
Name:WIMMER, JENNA LEA (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEA
Last Name:WIMMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEA
Other - Last Name:HUBNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4122 METRIC DR STE 800
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6809
Mailing Address - Country:US
Mailing Address - Phone:407-645-2577
Mailing Address - Fax:407-866-2793
Practice Address - Street 1:4122 METRIC DR STE 800
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6809
Practice Address - Country:US
Practice Address - Phone:407-645-2577
Practice Address - Fax:407-866-2793
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9254453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000574100Medicaid
FL000574100Medicaid