Provider Demographics
NPI:1265700595
Name:STEVICK, JENNIFER ANN (NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:STEVICK
Suffix:
Gender:F
Credentials:NP-C
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 0070
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0070
Mailing Address - Country:US
Mailing Address - Phone:229-259-4600
Mailing Address - Fax:229-259-4633
Practice Address - Street 1:2501 N. PATTERSON STREET
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-259-4600
Practice Address - Fax:229-259-4633
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily