Provider Demographics
NPI:1093341273
Name:NIX, JENNIFER J (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:NIX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:GOODBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3120 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4512
Mailing Address - Country:US
Mailing Address - Phone:724-342-2663
Mailing Address - Fax:724-342-6247
Practice Address - Street 1:3120 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4512
Practice Address - Country:US
Practice Address - Phone:724-342-2663
Practice Address - Fax:724-342-6247
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021384363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology