Provider Demographics
NPI:1104393180
Name:SARNA, JENNA NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:SARNA
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 1:631 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9517
Mailing Address - Country:US
Mailing Address - Phone:708-257-4450
Mailing Address - Fax:
Practice Address - Street 1:400 S KENNEDY DR STE 700
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2639
Practice Address - Country:US
Practice Address - Phone:815-935-7532
Practice Address - Fax:815-935-7495
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily