Provider Demographics
NPI:1407887219
Name:STURCKEN, JENNIFER IRENE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:STURCKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 EXECUTIVE PL STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5713
Mailing Address - Country:US
Mailing Address - Phone:910-677-9488
Mailing Address - Fax:866-694-9185
Practice Address - Street 1:609 EXECUTIVE PL STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5713
Practice Address - Country:US
Practice Address - Phone:910-677-9488
Practice Address - Fax:866-694-9185
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-01-31
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-01-25
Provider Licenses
StateLicense IDTaxonomies
NC0010-00389363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical