Provider Demographics
NPI:1104009026
Name:HAMBLIN, JENNIFER ANN (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7132
Mailing Address - Fax:585-723-7407
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7132
Practice Address - Fax:585-723-7407
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12326363AM0700X
NY012326363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2303 (GROUP 70008AMedicare PIN
NYPA2304 (BA0017 GRP)Medicare PIN