Provider Demographics
NPI:1629460050
Name:FEDEROFF, JENNA DANIELLE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:DANIELLE
Last Name:FEDEROFF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SCOTTDALE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9421
Mailing Address - Country:US
Mailing Address - Phone:412-974-8802
Mailing Address - Fax:
Practice Address - Street 1:420 E NORTH AVE
Practice Address - Street 2:#205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4746
Practice Address - Country:US
Practice Address - Phone:412-359-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily