Provider Demographics
NPI:1578034013
Name:GAY, JENNIFER L (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GAY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 34TH AVE S # 424
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1637
Mailing Address - Country:US
Mailing Address - Phone:651-313-8080
Mailing Address - Fax:651-925-0610
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-581-6400
Practice Address - Fax:763-581-6401
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2118615163W00000X
MN6328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse