Provider Demographics
NPI:1699181974
Name:ELDRIDGE, JENNIFER DENISE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DENISE
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:DENISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1160 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-500-4813
Mailing Address - Fax:855-807-5397
Practice Address - Street 1:7785 N. STATE STREET, COUNTY GENERAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367
Practice Address - Country:US
Practice Address - Phone:315-376-5252
Practice Address - Fax:855-807-5397
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338845-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00871292Medicaid
NY00871292Medicaid