Provider Demographics
NPI:1417565912
Name:HENNESSEY, JENAE CAMILLE (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENAE
Middle Name:CAMILLE
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 LAKEWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2093
Mailing Address - Country:US
Mailing Address - Phone:207-877-1719
Mailing Address - Fax:
Practice Address - Street 1:3278 LAKEWOOD DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2093
Practice Address - Country:US
Practice Address - Phone:207-877-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily