Provider Demographics
NPI:1689785404
Name:JENNINGS, ANTHONY JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOHN
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:JOHN
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2820 F STREET
Mailing Address - Street 2:
Mailing Address - City:SAC
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3718
Mailing Address - Country:US
Mailing Address - Phone:916-447-7863
Mailing Address - Fax:
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:SUITE 1300
Practice Address - City:SAC
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-874-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN499271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse