Provider Demographics
NPI:1346592649
Name:ROCK, JENNIFER BRIE (PNP-CP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BRIE
Last Name:ROCK
Suffix:
Gender:F
Credentials:PNP-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MEDICAL CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR JOHNSON AFB
Mailing Address - State:NC
Mailing Address - Zip Code:27531
Mailing Address - Country:US
Mailing Address - Phone:919-722-1551
Mailing Address - Fax:919-722-4665
Practice Address - Street 1:2803 MEDICAL CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:SEYMOUR JOHNSON AFB
Practice Address - State:NC
Practice Address - Zip Code:27531
Practice Address - Country:US
Practice Address - Phone:919-722-1551
Practice Address - Fax:919-722-4665
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCPN02124363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02124OtherCPN LICENSE