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Provider Information for 1669582821

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MRS. JAN DENICE PHELPS ARNP

Gender: FEMALE

Individual NPI: 1669582821

Calendar   Last Updated:  2020-03-05
  Certification Date:  2020-03-05

Details

Name Value
NPI 1669582821
Enumeration Date 2006-08-30
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 270 MAIN ST N STE 300
STILLWATER, MN 55082-6788
United States

Phone: 651-342-1039 | Fax: 651-342-1428
View Map External Link
Primary Practice Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610
United States

Phone: 813-259-1013 | Fax:
View Map External Link
Secondary Practice Address 1442 W BUSCH BLVD
TAMPA, FL 33612-7602
United States

Phone: 813-931-9094 | Fax: 813-935-1126
View Map External Link

1442 W BUSCH BLVD
TAMPA, FL 33612-7602
United States

Phone: 813-931-9094 | Fax: 813-935-1126
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other LICENSE NUMBER FL 1851392
MEDICAID FL 305568000
Other NPI BUSINESS FL 1326237850
Other NPI FL 1669582821
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL 1851392