Provider Demographics
NPI:1114792595
Name:AGUILAR, JENNA-MARA (RN)
Entity Type:Individual
Prefix:
First Name:JENNA-MARA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNA-MARA
Other - Middle Name:
Other - Last Name:CASINGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:172 OLDE FARM RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8775
Mailing Address - Country:US
Mailing Address - Phone:551-358-1305
Mailing Address - Fax:
Practice Address - Street 1:1421 BLUFF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4809
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC273628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse