Provider Demographics
NPI:1437741535
Name:TOBIN, JENNA LEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LEE
Last Name:TOBIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHADOWMOSS PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6845
Mailing Address - Country:US
Mailing Address - Phone:610-761-7768
Mailing Address - Fax:
Practice Address - Street 1:100 SHADOWMOSS PKWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6845
Practice Address - Country:US
Practice Address - Phone:610-761-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10764363LF0000X
SC24668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily