Provider Demographics
NPI:1790545861
Name:MINDER, JENNA LYNN
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:MINDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SIDETRACK CIR
Mailing Address - Street 2:
Mailing Address - City:COMER
Mailing Address - State:GA
Mailing Address - Zip Code:30629-4046
Mailing Address - Country:US
Mailing Address - Phone:810-399-8788
Mailing Address - Fax:
Practice Address - Street 1:500 WASHINGTON ST SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3628
Practice Address - Country:US
Practice Address - Phone:810-399-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant