JENNIFER R JACK CPNP
NPI 1184045148
Nurse Practitioner - Pediatrics in Fort Myers, FL
NPI Status: Active since December 18, 2013
Contact Information
15901 BASS RD STE 102
FORT MYERS, FL
ZIP 33908
Phone: (239) 343-9890
Fax: (239) 343-9898
- Individual
- Female
- Nurse Practitioner
- Pediatrics
- Accepts Insurance
- PECOS Enrolled
About JENNIFER JACK
This page provides the complete NPI Profile along with additional information for Jennifer Jack, a provider established in Fort Myers, Florida with a medical specialization in Nurse Practitioner, focusing in pediatrics . The healthcare provider is registered in the NPI registry with number 1184045148 assigned on December 2013. The practitioner's primary taxonomy code is 363LP0200X with license number APRN11019090 (FL). The provider is registered as an individual and her NPI record was last updated 4 years ago.
- NPI
- 1184045148
- Provider Name
- JENNIFER R JACK CPNP
- Other Name
- JENNIFER R WALLACE
- Other Name Type
- Former Name (1)
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 15901 BASS RD STE 102 FORT MYERS, FL 33908
- Location Phone
- (239) 343-9890
- Location Fax
- (239) 343-9898
- Mailing Address
- PO BOX 2147 FORT MYERS, FL 33902
- Mailing Phone
- (239) 343-9890
- Mailing Fax
- (239) 343-9898
- Is Sole Proprietor?
- No
- Enumeration Date
- 12-18-2013
- Last Update Date
- 05-03-2022
- Code Navigator
A nurse practitioner (NP) like Jennifer Jack is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Practitioner Pediatrics
- Taxonomy Code
- 363LP0200X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- APRN11019090
- License State
- FL
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 28148319A (IN) |
| 2 | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 71004791A (IN) |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- AvMed Entrust Bronze 600 (2026) - HMO
- AvMed Entrust Bronze 650 (2026) - HMO
- AvMed Entrust Expanded Bronze Standard (2026) - HMO
- AvMed Entrust Gold 125 (2026) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2026) - HMO
- AvMed Entrust Gold Standard (2026) - HMO
- AvMed Entrust Platinum 25 (2026) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2026) - HMO
- AvMed Entrust Platinum Standard (2026) - HMO
- AvMed Entrust Silver 350 (2026) - HMO
- AvMed Entrust Silver 350 Dental+Vision (2026) - HMO
- AvMed Entrust Silver 550 (2026) - HMO
- AvMed Entrust Silver 550 Dental+Vision (2026) - HMO
- AvMed Entrust Silver Standard (2026) - HMO
- Bronze 7500 $25 Generic Drugs - HMO
- Bronze 7500 $25 Generic Drugs + Adult Vision & Fitness - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services - HMO
- Diabetes Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Gold 2000 $15 Generic Drugs - HMO
- Gold 2000 $15 Generic Drugs + Adult Vision & Fitness - HMO
- HDHP Preventive Silver 5500 $0 Chronic Care Drugs - HMO
- Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services - HMO
- Healthy Heart Gold 3000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services - HMO
- Healthy Heart Silver 5000 $0 Chronic Care Drugs & Services + Adult Vision & Fitness - HMO
- HSA Eligible Bronze 6000 - HMO
- Low Premium Bronze 10600 $25 Generic Drugs - HMO
- Low Premium Bronze 10600 $25 Generic Drugs + Adult Vision & Fitness - HMO
- Low Premium Silver 6200 $3 Generic Drugs - HMO
- Low Premium Silver 6200 $3 Generic Drugs + Adult Vision & Fitness - HMO
- Platinum Zero $5 Generic Drugs - HMO
- Platinum Zero $5 Generic Drugs + Adult Vision & Fitness - HMO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 113907600 | MEDICAID (05) | FL |
Medicare Participation & PECOS Enrollment Status
Jennifer Jack is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 33908 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $91.69
- Minimum New Patient Price $58.56
- Maximum New Patient Price $179.05
- Average New Patient Copayment $22.92
- Minimum New Patient Copayment $14.64
- Maximum New Patient Copayment $44.76
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99214
- Average Established Patient Price $103.21
- Minimum Established Patient Price $18.44
- Maximum Established Patient Price $144.68
- Average Established Patient Copayment $25.8
- Minimum Established Patient Copayment $4.61
- Maximum Established Patient Copayment $36.17
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1184045148, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 52. The final step is to find the difference between that total and the next multiple of ten (60 - 52 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 52 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 12 providers are registered at the same or a nearby location.
FORT MYERS, FL 33908
FORT MYERS, FL 33908
FORT MYERS, FL 33908
FORT MYERS, FL 33908
FORT MYERS, FL 33908
FORT MYERS, FL 33908
FORT MYERS, FL 33908
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1184045148, enumerated as an "individual" on December 18, 2013.
The provider is located at 15901 BASS RD STE 102 FORT MYERS, FL 33908 and the phone number is (239) 343-9890.
Nurse Practitioner with taxonomy code 363LP0200X and a focus in Pediatrics.
The provider might be accepting Accepts: AvMed, CareSource, Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
