Jennifer R Jack
CPNP | Nurse Practitioner - Pediatrics
15901 Bass Rd Ste 102, Fort Myers
Florida, 33908-3838
239-343-9890
Jennifer R Jack is a Fort Myers, Florida based nurse practitioner who is specialized as Pediatrics nurse. Active license number of Jennifer R Jack is APRN11019090 for Pediatrics in Florida. Her current practice location is 15901 Bass Rd Ste 102, Fort Myers. Patients can reach her at 239-343-9890 or can fax her at 239-343-9898. Jennifer R Jack is CPNP with specialization in Pediatrics and her NPI number (Unique professional ID assigned by NPPES) is 1184045148.
Jennifer R Jack specializes in caring for newborns, infants, toddlers, adolescents and young adults. She perform pediatric health care maintenance, including well child exams, developmental screenings and in-depth physical assessments, such as vision, hearing and dental. Pediatrics Nurse Practitioner (PNP) focus on well-child care and the prevention or management of common pediatric acute illnesses and chronic conditions.
Complete Profile:
Jennifer R Jack speciality, credentials, practice address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointment.
| Name: | Jennifer R Jack |
| Specialization: | Pediatrics Nurse Practitioner (PNP) |
| Gender: | Female |
| Credentials: | CPNP |
| Practice Address: | 15901 Bass Rd Ste 102, Fort Myers,
Florida, 33908-3838 |
| Phone: | 239-343-9890 |
| Fax: | 239-343-9898 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1184045148 |
| NPI Enumeration Date: | 18 Dec, 2013 |
| NPI Last Update On: | 03 May, 2022 |
Medical Licenses:
NPs can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Jennifer R Jack are as mentioned below.
| License Number | Specialization | State | Status | |
| APRN11019090 | Pediatrics | Florida | Primary | |
| 28148319A | Pediatrics | Indiana | Secondary | |
| 71004791A | Pediatrics | Indiana | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Jennifer R Jack such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 113907600 | Medicaid | Florida | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Jennifer R Jack
Po Box 2147,
Fort Myers, Florida |
| Zip: | 33902-2147 |
| Phone Number: | 239-343-9890 |
| Fax Number: | 239-343-9898 |
Patients can reach Jennifer R Jack at
15901 Bass Rd Ste 102, Fort Myers, Florida or can
call to book an appointment on 239-343-9890.
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Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 October, 2025.