Provider Demographics
NPI:1235973751
Name:PANOC, JENNIFER LEA (MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:PANOC
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:818 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-5213
Mailing Address - Country:US
Mailing Address - Phone:267-253-0715
Mailing Address - Fax:
Practice Address - Street 1:681 HARLEYSVILLE PIKE FL 2
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2854
Practice Address - Country:US
Practice Address - Phone:215-264-2272
Practice Address - Fax:215-827-5159
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP029688364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health