Provider Demographics
NPI:1700407756
Name:GORGOL, JENNIFER LYNN (MSN, RN, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GORGOL
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP-BC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 CAMPUS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7542
Mailing Address - Country:US
Mailing Address - Phone:304-596-2150
Mailing Address - Fax:
Practice Address - Street 1:61 CAMPUS DR STE 200
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7542
Practice Address - Country:US
Practice Address - Phone:304-596-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273837363LA2100X, 363LA2100X
WV115196363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care