Provider Demographics
NPI:1093154510
Name:KOVACH, JEAN MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:KOVACH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 PENNELS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4946
Mailing Address - Country:US
Mailing Address - Phone:315-521-9494
Mailing Address - Fax:
Practice Address - Street 1:375 PENNELS DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4946
Practice Address - Country:US
Practice Address - Phone:315-521-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337261-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily