Provider Demographics
NPI:1326417759
Name:ZIMMERMAN, JENNIFER LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ICE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-9654
Mailing Address - Country:US
Mailing Address - Phone:570-552-4450
Mailing Address - Fax:
Practice Address - Street 1:308 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:HARDING
Practice Address - State:PA
Practice Address - Zip Code:18643-7153
Practice Address - Country:US
Practice Address - Phone:570-388-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily