Individual
JENNIFER RAE WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
150 SW CHAMBER CT STE 101, PORT ST LUCIE, FL 34986-3413
(772) 301-0123
(772) 301-0124
Mailing address
150 SW CHAMBER CT STE 101, PORT ST LUCIE, FL 34986-3413
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5001620
NC
363LP0200X
Pediatric Nurse Practitioner
0050-1620
NC
363LP0200X
Pediatric Nurse Practitioner
203964
NC
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN11008019
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629190731
—
NC
05
—
7005607
—
NC
05
—
NP3325
—
SC
Enumeration date
04/06/2007
Last updated
11/07/2023
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