Provider Demographics
NPI:1508642034
Name:DRIVER, JENN
Entity Type:Individual
Prefix:
First Name:JENN
Middle Name:
Last Name:DRIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 REVOLUTION WAY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1193
Mailing Address - Country:US
Mailing Address - Phone:214-918-3748
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST STE 209
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4436
Practice Address - Country:US
Practice Address - Phone:945-248-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program