Provider Demographics
NPI:1497394746
Name:FOSTER, JENNA (FNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HOLEVINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 AYRAULT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8941
Mailing Address - Country:US
Mailing Address - Phone:585-602-0440
Mailing Address - Fax:
Practice Address - Street 1:800 AYRAULT RD STE 100
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8941
Practice Address - Country:US
Practice Address - Phone:585-602-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-04
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345098363AM0700X
NYF345098-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical