Provider Demographics
NPI:1760459630
Name:CARPINELLO, JENIFFER CAROL (NP)
Entity Type:Individual
Prefix:
First Name:JENIFFER
Middle Name:CAROL
Last Name:CARPINELLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENIFFER
Other - Middle Name:CAROL
Other - Last Name:CULBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:200 S ENOTA DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3473
Mailing Address - Country:US
Mailing Address - Phone:770-534-2020
Mailing Address - Fax:770-534-8025
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-534-2020
Practice Address - Fax:770-534-8025
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN120116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10053121OtherAMERIGROUP
GA0008947616CMedicaid
GA340826OtherWELLCARE
GAP00094015OtherRR MEDICARE-GRP # CC4177
GA10053121OtherAMERIGROUP
50BBGMQMedicare ID - Type Unspecified