Provider Demographics
NPI:1033814173
Name:JENTZ, BRITTINI LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRITTINI
Middle Name:LEE
Last Name:JENTZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 W ROSCOE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2357
Mailing Address - Country:US
Mailing Address - Phone:972-816-8781
Mailing Address - Fax:
Practice Address - Street 1:920 W ROSCOE ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2357
Practice Address - Country:US
Practice Address - Phone:972-816-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041524205163W00000X
IL209.027045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse