Provider Demographics
NPI:1871556993
Name:JENNINGS, STEPHANIE A (CRNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COMMUNITY DR STE E
Mailing Address - Street 2:SUITE E
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8992
Mailing Address - Country:US
Mailing Address - Phone:570-839-9880
Mailing Address - Fax:570-839-9885
Practice Address - Street 1:300 COMMUNITY DR STE E
Practice Address - Street 2:SUITE E
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8992
Practice Address - Country:US
Practice Address - Phone:570-839-9880
Practice Address - Fax:570-839-9885
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005534B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P78171Medicare UPIN
PA066319PZPMedicare ID - Type Unspecified