Individual
JENNILEE HARRIET BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 BAYSHORE BLVD UNIT 1203, TAMPA, FL 33629-7304
(267) 342-5084
Mailing address
2401 BAYSHORE BLVD UNIT 1203, TAMPA, FL 33629-7304
(267) 342-5084
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9324727
FL
Other
Enumeration date
03/28/2018
Last updated
03/28/2018
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