Provider Demographics
NPI:1942805072
Name:MCCARTHY, JENNIFER SUZANNE (MSN, APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUZANNE
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MSN, APRN, CNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:SUZANNE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2720 FAIRVIEW AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1306
Mailing Address - Country:US
Mailing Address - Phone:651-241-5290
Mailing Address - Fax:
Practice Address - Street 1:2720 FAIRVIEW AVE N STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1306
Practice Address - Country:US
Practice Address - Phone:651-241-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily