Provider Demographics
NPI:1043738321
Name:DELSAPIO, JENNA A (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:A
Last Name:DELSAPIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:A
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-9000
Mailing Address - Country:US
Mailing Address - Phone:508-627-5797
Mailing Address - Fax:508-939-8644
Practice Address - Street 1:245 EDGARTOWN VINEYARD HAVEN RD
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-6948
Practice Address - Country:US
Practice Address - Phone:508-627-5797
Practice Address - Fax:508-939-8644
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308224363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics