Provider Demographics
NPI:1770547853
Name:ALLEN, JENNIFER (CNM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18868
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32523-8868
Mailing Address - Country:US
Mailing Address - Phone:850-994-5660
Mailing Address - Fax:850-994-5841
Practice Address - Street 1:525 BRENT LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2003
Practice Address - Country:US
Practice Address - Phone:850-471-2221
Practice Address - Fax:850-471-2245
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2696662367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301431200Medicaid
AL59167875OtherBCBS AL
FLY4875OtherBCBS FL
AL59167875OtherBCBS AL
FLY4875XMedicare ID - Type Unspecified