Provider Demographics
NPI:1659897783
Name:ZENGERLE, JESSICA A (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ZENGERLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:32-36 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1840
Mailing Address - Country:US
Mailing Address - Phone:570-723-0104
Mailing Address - Fax:
Practice Address - Street 1:103 FORESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:ELKLAND
Practice Address - State:PA
Practice Address - Zip Code:16920
Practice Address - Country:US
Practice Address - Phone:814-258-5117
Practice Address - Fax:814-258-5510
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily