Provider Demographics
NPI:1235680430
Name:JEANTY, JENNIFER (APN-C, DNP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:JEANTY
Suffix:
Gender:F
Credentials:APN-C, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1233
Mailing Address - Country:US
Mailing Address - Phone:973-957-0871
Mailing Address - Fax:
Practice Address - Street 1:280 W MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-957-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00671200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner