Provider Demographics
NPI:1992126718
Name:SWEAT, JENNIFER RENEE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:SWEAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 SAN JOSE PL
Mailing Address - Street 2:STE 22
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2436
Mailing Address - Country:US
Mailing Address - Phone:904-928-0112
Mailing Address - Fax:904-928-0112
Practice Address - Street 1:3771 SAN JOSE PL
Practice Address - Street 2:STE 22
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2436
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:904-928-0112
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist