Provider Demographics
NPI:1124402904
Name:CHIEPPA, JENNIFER GRANDE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GRANDE
Last Name:CHIEPPA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JUANGA
Other - Last Name:GRANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:385 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1151
Practice Address - Country:US
Practice Address - Phone:733-792-1119
Practice Address - Fax:973-379-2807
Is Sole Proprietor?:No
Enumeration Date:2015-07-12
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00574400363LA2200X, 363LG0600X, 363LP2300X
NJ25NJ00574400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care