Basic Information
| Provider Information | |||||||||
| NPI: | 1831446079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNELL | ||||||||
| FirstName: | JEANETTE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DNP, ACNP-BC, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 W HIGHWAY 98 | ||||||||
| Address2: | NAVAL HOSPITAL PENSACOLA | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325127406 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 W HIGHWAY 98 | ||||||||
| Address2: | NAVAL HOSPITAL PENSACOLA | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325127406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505056199 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 04/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 9188144 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2100X | ARNP 9188144 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.