Provider Demographics
NPI:1396133435
Name:GUGLIA, JENNIFER (MS, NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUGLIA
Suffix:
Gender:F
Credentials:MS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WINFISKY DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2013
Mailing Address - Country:US
Mailing Address - Phone:781-439-0281
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVENUE
Practice Address - Street 2:M1B33
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-3331
Practice Address - Fax:617-362-3892
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN247134363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health