Basic Information
Provider Information
NPI: 1003151309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARGUILLA
FirstName: JENNIFER
MiddleName: SALENGA
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SALENGA
OtherFirstName: JENNIFER
OtherMiddleName: BULANAN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 8773 PERIMETER PARK CT
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322161165
CountryCode: US
TelephoneNumber: 9044933390
FaxNumber: 9044933395
Practice Location
Address1: 8773 PERIMETER PARK CT
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322161165
CountryCode: US
TelephoneNumber: 9044933390
FaxNumber: 9044933395
Other Information
ProviderEnumerationDate: 11/28/2012
LastUpdateDate: 08/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XARNP3386672FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
Y0FX401FLFLORIDA BLUEOTHER
4568101FLMEDICARE - GROUPOTHER
GW727Z01FLMEDICARE - INDIVIDUALOTHER


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