Provider Demographics
NPI:1033562681
Name:SPANN, JENNIFER ALLISON (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALLISON
Last Name:SPANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 HIGHWAY 280 STE 130
Mailing Address - Street 2:
Mailing Address - City:ALEX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3375
Mailing Address - Country:US
Mailing Address - Phone:256-234-2644
Mailing Address - Fax:256-234-2704
Practice Address - Street 1:3368 HIGHWAY 280 STE 130
Practice Address - Street 2:
Practice Address - City:ALEX CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3375
Practice Address - Country:US
Practice Address - Phone:256-234-2644
Practice Address - Fax:256-234-2704
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily