| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENNIFER RUSS CHILDERS | 1831643485 | 2021-11-21 |
Jennifer Russ Childers is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1831643485. Registration indicates Jennifer Russ Childers 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, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Mrs. Jennifer Russ Childers APRN |
| Practice Office Address | 121 W MACCLENNY AVE MACCLENNY, FL US |
| Practice Office Telephone | 9042596380 |
| Mailing Address | 121 W MACCLENNY AVE MACCLENNY, FL 320632029 US |
| Business Telephone | 9042596380 |
| 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 | APRN3253932
FL |