Provider Demographics
NPI:1750922902
Name:MUGGRIDGE, JENNIFER MARIA (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIA
Last Name:MUGGRIDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-0787
Mailing Address - Country:US
Mailing Address - Phone:423-658-1406
Mailing Address - Fax:865-281-1625
Practice Address - Street 1:2702 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-4850
Practice Address - Country:US
Practice Address - Phone:423-658-1406
Practice Address - Fax:865-281-1625
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN25916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily