Provider Demographics
NPI:1609268093
Name:TAVARES, JENNY (RN)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TAVARES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:508-984-8420
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-984-8420
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294487163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse