Provider Demographics
NPI:1568898542
Name:ROBERTS, JENNA
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:ROBERTS
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 1:47747 TWIN PINES RD
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-9658
Mailing Address - Country:US
Mailing Address - Phone:609-500-0239
Mailing Address - Fax:
Practice Address - Street 1:655 MONTGOMERY ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2677
Practice Address - Country:US
Practice Address - Phone:844-847-8216
Practice Address - Fax:415-520-9150
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165146363LF0000X
NJ26NJ00660800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily