Independent site. Not affiliated with, endorsed by, or connected to DoD, DHA, or the official TRICARE program. Visit the official TRICARE site.

HomeProvidersJENNIFER JACK CPNP

Nurse Practitioner, Pediatrics

JENNIFER JACK CPNP

Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.

Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.

Public record

NPI 1184045148 · enumerated 2013-12-18 · record updated 2022-05-03. Source: CMS NPPES. A listing is not a TRICARE network approval.

NPPES record Google Maps Apple Maps OpenStreetMap

Other names: JENNIFER WALLACE

Addresses and phones

Practice location 15901 BASS RD STE 102, FORT MYERS, FL, 33908-3838 (239) 343-9890 Fax (239) 343-9898 Google Maps Apple Maps OpenStreetMap
Mailing address PO BOX 2147, FORT MYERS, FL, 33902-2147 (239) 343-9890 Fax (239) 343-9898 Google Maps Apple Maps OpenStreetMap

Specialties

Nurse Practitioner, Pediatrics 363LP0200X · License 28148319A IN
Nurse Practitioner, Pediatrics 363LP0200X · License 71004791A IN
Nurse Practitioner, Pediatrics 363LP0200X · Primary · License APRN11019090 FL

In this directory

FL Lee County Fort Myers Nurse Practitioner, Pediatrics

Locations and evidence

Practice location FORT MYERS, FL, 339083838
Accepting new patientsNot reportedCMS NPPES · September 30, 2026

Plan acceptance

No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.