Provider Demographics
NPI:1457116626
Name:HARRIS, JENNY MCFADDIN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MCFADDIN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JENNY
Other - Middle Name:LEE
Other - Last Name:MCFADDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 SAINT CLAIR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1033
Mailing Address - Country:US
Mailing Address - Phone:803-468-4748
Mailing Address - Fax:
Practice Address - Street 1:3400 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4782
Practice Address - Country:US
Practice Address - Phone:912-466-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP002043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily