Provider Demographics
NPI:1851859250
Name:BOIVIN, JENNA LEVESQUE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEVESQUE
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ROSE
Other - Last Name:LEVESQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:7777 FOREST LN STE C840
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6868
Mailing Address - Country:US
Mailing Address - Phone:972-566-7000
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C840
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6868
Practice Address - Country:US
Practice Address - Phone:972-566-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139527363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner