Provider Demographics
NPI:1568599223
Name:TINSMAN, JENNIFER CYR (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CYR
Last Name:TINSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:215 STRATTON RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4621
Practice Address - Country:US
Practice Address - Phone:802-773-3386
Practice Address - Fax:802-773-4578
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030720363A00000X, 363A00000X
VT055-0030764363A00000X
VT055-0030794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000313Medicaid
VT9000313Medicaid
AP2345Medicare ID - Type Unspecified