Provider Demographics
NPI:1871766543
Name:HINDERER, JENNIFER OLIVER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:OLIVER
Last Name:HINDERER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2804
Mailing Address - Country:US
Mailing Address - Phone:813-857-4684
Mailing Address - Fax:
Practice Address - Street 1:20 DUKE MEDICINE CIR # 3-2
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4205
Practice Address - Country:US
Practice Address - Phone:919-684-4891
Practice Address - Fax:919-684-8508
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1586363A00000X, 363AM0700X
363AS0400X
NC0010-11143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1851446017OtherGROUP NPI
TN1588719744OtherLC GROUP NPI
TN3665225Medicaid
3376146Medicare PIN
TN0677340004Medicare NSC
TN0677340001Medicare NSC
TN103I970070Medicare PIN
TN3665225Medicaid