Provider Demographics
NPI:1609150226
Name:TITCHNELL, JENNIFER LYNNE (PAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:TITCHNELL
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 1:575 HUDSON VALLEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4747
Mailing Address - Country:US
Mailing Address - Phone:845-220-2270
Mailing Address - Fax:845-220-2277
Practice Address - Street 1:575 HUDSON VALLEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-4747
Practice Address - Country:US
Practice Address - Phone:845-220-2270
Practice Address - Fax:845-220-2277
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014504-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical