Provider Demographics
NPI:1558357087
Name:DELARBER, JENNIFER LYNN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:DELARBER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6646
Mailing Address - Country:US
Mailing Address - Phone:229-226-0125
Mailing Address - Fax:229-226-0195
Practice Address - Street 1:508 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6646
Practice Address - Country:US
Practice Address - Phone:229-226-0125
Practice Address - Fax:229-226-0195
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA448826836AMedicaid
GA448826836AMedicaid
FLE4071ZMedicare ID - Type Unspecified
FLP05762001Medicare UPIN