Provider Demographics
NPI:1053092288
Name:AGOSTO, JENNIFER MARIE (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7072
Mailing Address - Country:US
Mailing Address - Phone:305-588-0373
Mailing Address - Fax:
Practice Address - Street 1:60 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7072
Practice Address - Country:US
Practice Address - Phone:305-588-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care