Provider Demographics
NPI:1184123473
Name:JENNINGS, BROOKE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-4027
Mailing Address - Fax:220-564-4012
Practice Address - Street 1:1210 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2806
Practice Address - Country:US
Practice Address - Phone:740-454-8551
Practice Address - Fax:740-454-2411
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner