Provider Demographics
NPI:1962479691
Name:HALE, JENNIFER LYNNE (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:HALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:843-553-7070
Mailing Address - Fax:843-553-2223
Practice Address - Street 1:9326 MEDICAL PLAZA DR
Practice Address - Street 2:STE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9138
Practice Address - Country:US
Practice Address - Phone:843-553-7070
Practice Address - Fax:843-553-2223
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 2549367500000X
FLARNP9288188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1382Medicaid
CS488ZMedicare PIN
SCQ339103605Medicare ID - Type Unspecified
SCAN1382Medicaid