Provider Demographics
NPI:1639647225
Name:SYLESTINE, JENNIFER MIZZELL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MIZZELL
Last Name:SYLESTINE
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 1:465 HEASLETTS VIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-5317
Mailing Address - Country:US
Mailing Address - Phone:256-510-0248
Mailing Address - Fax:
Practice Address - Street 1:208 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2432
Practice Address - Country:US
Practice Address - Phone:256-249-0943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF05180582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily