Provider Demographics
NPI:1841751427
Name:FITZGIBBONS, JEAN (CRNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALLEGHENY CTR FL 7
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5255
Mailing Address - Country:US
Mailing Address - Phone:412-330-5961
Mailing Address - Fax:412-330-5844
Practice Address - Street 1:1307 FEDERAL ST STE B201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4774
Practice Address - Country:US
Practice Address - Phone:412-359-3355
Practice Address - Fax:412-359-6216
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103611317Medicaid