Provider Demographics
NPI:1780338145
Name:TRICKETT, JENNIFER A (APRN, CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:TRICKETT
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B305
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8418
Mailing Address - Country:US
Mailing Address - Phone:847-802-7400
Mailing Address - Fax:847-802-7399
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B305
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8418
Practice Address - Country:US
Practice Address - Phone:847-802-7400
Practice Address - Fax:847-802-7399
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024712363L00000X
IL209024712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty