Provider Demographics
NPI:1265929681
Name:HARRISON, JENNIFER NEEDS DEMARTINO (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NEEDS DEMARTINO
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-1776
Mailing Address - Country:US
Mailing Address - Phone:252-423-4300
Mailing Address - Fax:252-862-2684
Practice Address - Street 1:2917 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-9027
Practice Address - Country:US
Practice Address - Phone:954-873-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01507207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine