Provider Demographics
NPI:1295170009
Name:CATANZARO, JENNIFER (ANP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CATANZARO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:CATANZARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:4210 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6521
Mailing Address - Country:US
Mailing Address - Phone:919-784-6639
Mailing Address - Fax:919-784-6673
Practice Address - Street 1:4210 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6521
Practice Address - Country:US
Practice Address - Phone:919-784-6639
Practice Address - Fax:919-784-6673
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006185363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health