Provider Demographics
NPI:1013030824
Name:GREEN, JENNIFER JACQUELYN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JACQUELYN
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:JACQUELYN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:25 SHERINGTON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-757-5559
Mailing Address - Fax:843-757-5546
Practice Address - Street 1:25 SHERINGTON DR
Practice Address - Street 2:SUITE D
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-757-5559
Practice Address - Fax:843-757-5546
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2999363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health