Provider Demographics
NPI:1801293808
Name:BLETZACKER, JENNA D (WHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:D
Last Name:BLETZACKER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:C
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:222 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1852
Practice Address - Country:US
Practice Address - Phone:629-255-2269
Practice Address - Fax:629-255-4249
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19385363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN19385OtherAPN LICENSE