Provider Demographics
NPI:1255138483
Name:FORD, JENNIFER JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:FORD
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 HILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4730
Mailing Address - Country:US
Mailing Address - Phone:920-904-5539
Mailing Address - Fax:
Practice Address - Street 1:295 HILLCREST LN
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4730
Practice Address - Country:US
Practice Address - Phone:920-904-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16485-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily