Provider Demographics
NPI:1689213332
Name:PLEAN, JENNA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:PLEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9304 PEARCH LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3631
Mailing Address - Country:US
Mailing Address - Phone:908-839-2778
Mailing Address - Fax:
Practice Address - Street 1:500 LEONARD ST APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6087
Practice Address - Country:US
Practice Address - Phone:908-839-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant