Provider Demographics
NPI:1114276078
Name:CULBRETH, JENNIFER LAUREN (ANP-BC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:CULBRETH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MEMORIAL LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1220
Mailing Address - Country:US
Mailing Address - Phone:912-897-3766
Mailing Address - Fax:912-898-0809
Practice Address - Street 1:1001 MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1220
Practice Address - Country:US
Practice Address - Phone:912-897-3766
Practice Address - Fax:912-898-0809
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188387363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128469BMedicaid
GA003128469AMedicaid
GAP01119002OtherRAILROAD MEDICARE
GA2025044I34Medicare PIN