Provider Demographics
NPI:1710676879
Name:CONNOLLY, JENNA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 GREEN ST APT 409
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1939
Mailing Address - Country:US
Mailing Address - Phone:240-535-8803
Mailing Address - Fax:
Practice Address - Street 1:231 SUTTON ST STE 1D
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1620
Practice Address - Country:US
Practice Address - Phone:978-686-3877
Practice Address - Fax:978-975-9586
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily