Provider Demographics
NPI:1578823639
Name:WEISS, JENNIFER MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:WEISS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:HOCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC, APRN-CNP
Mailing Address - Street 1:5966 W CURTISIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8801
Mailing Address - Country:US
Mailing Address - Phone:082-302-5470
Mailing Address - Fax:208-302-5455
Practice Address - Street 1:5966 W CURTISIAN AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8801
Practice Address - Country:US
Practice Address - Phone:208-302-5470
Practice Address - Fax:208-302-5455
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2024-02-01
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-03-17
Provider Licenses
StateLicense IDTaxonomies
ID71999363LA2100X, 363LG0600X
CA5556225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist