Provider Demographics
NPI:1073391926
Name:ANTHONY, JENNA LEE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEE
Other - Last Name:TYMKOWICHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:EAST OTIS
Mailing Address - State:MA
Mailing Address - Zip Code:01029-0753
Mailing Address - Country:US
Mailing Address - Phone:413-531-1507
Mailing Address - Fax:
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5381
Practice Address - Country:US
Practice Address - Phone:413-531-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2308152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily