Provider Demographics
NPI:1407564248
Name:VAUGHAN, JENNA (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:VAUGHAN
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 1:65 E BUTLER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5219
Mailing Address - Country:US
Mailing Address - Phone:215-822-3113
Mailing Address - Fax:215-822-0889
Practice Address - Street 1:65 E BUTLER AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5219
Practice Address - Country:US
Practice Address - Phone:215-822-3113
Practice Address - Fax:215-822-0889
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily