Provider Demographics
NPI:1407523327
Name:PUGH, JENNA C (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:C
Last Name:PUGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:C
Other - Last Name:BENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-3884
Mailing Address - Fax:717-851-3382
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-851-3882
Practice Address - Fax:717-851-3384
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024137363LF0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily