| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENNIFER LYNN WALLER | 1821728395 | 2023-02-11 |
Jennifer Lynn Waller is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1821728395. Registration indicates Jennifer Lynn Waller is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Family, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Family, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Entity Type | Individual |
| Provider Name | Jennifer Lynn Waller APRN |
| Other Provider Name | Jennifer Lynn Waller |
| Practice Office Address | 14502 N DALE MABRY HWY TAMPA, FL US |
| Practice Office Telephone | 8013809155 |
| Mailing Address | 14502 N DALE MABRY HWY TAMPA, FL 336182075 US |
| Business Telephone | 8013809155 |
| Code | Practice | License No State |
|---|---|---|
| 363LF0000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Family All Other Specialties & Provider Types Nurse Practitioner Family Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 11017307
FL |