Provider Demographics
NPI:1629026646
Name:TAPPIN-ADDISON, JENNIFER R (AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:TAPPIN-ADDISON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:TAPPIN-ADDISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:4600 MORNING GLORY LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6871
Mailing Address - Country:US
Mailing Address - Phone:907-443-6761
Mailing Address - Fax:
Practice Address - Street 1:NORTON SHORE HEALTH CORPORATION
Practice Address - Street 2:1000 GREG KRUSCHEK AVE
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4775-1163WM0102X
TXAP134042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn