Basic Information
| Provider Information | |||||||||
| NPI: | 1790328094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERR | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MSN APRN NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3050 BRYCE CT | ||||||||
| Address2: | |||||||||
| City: | DELTONA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327387968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123066693 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1630 MASON AVE STE C | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321174503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862389064 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2019 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28220237A | IN | N | Nursing Service Providers | Registered Nurse | 163W00000X | 9556993 | FL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F09190634 | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 11011720 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.