Provider Demographics
NPI:1760107940
Name:RABENOLD, JENNIE (NP)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:RABENOLD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3847 FEATHERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4169
Mailing Address - Country:US
Mailing Address - Phone:904-599-9085
Mailing Address - Fax:
Practice Address - Street 1:3847 FEATHERSTONE CT
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4169
Practice Address - Country:US
Practice Address - Phone:904-599-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily