Provider Demographics
NPI:1902032915
Name:CANTRELL, JENNIFER SUZANNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 AUBURN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1676
Mailing Address - Country:US
Mailing Address - Phone:678-288-4142
Mailing Address - Fax:
Practice Address - Street 1:1862 AUBURN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1676
Practice Address - Country:US
Practice Address - Phone:678-288-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166999NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics