Provider Demographics
NPI:1730649484
Name:FOSTER, JENNIE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:MICHELLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 TAMIAMI TRL N UNIT 301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3034
Mailing Address - Country:US
Mailing Address - Phone:239-935-5721
Mailing Address - Fax:
Practice Address - Street 1:3282 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8875
Practice Address - Country:US
Practice Address - Phone:252-756-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013519207Q00000X, 363LG0600X
NJ26NR20759700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care