Provider Demographics
NPI:1730845942
Name:GLEVIS, JHEANELLE R (APRN)
Entity type:Individual
Prefix:
First Name:JHEANELLE
Middle Name:R
Last Name:GLEVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JHEANELLE
Other - Middle Name:R
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1804 OAKLEY SEAVER DR STE F
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1804 OAKLEY SEAVER DR STE F
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:407-499-0755
Practice Address - Fax:949-543-2564
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029332363LF0000X
FL11029332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily