Provider Demographics
NPI:1811246978
Name:TAWA, JENNIFER A (APRN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:TAWA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 RIVERWAY PL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6730
Mailing Address - Country:US
Mailing Address - Phone:603-262-1424
Mailing Address - Fax:603-506-6825
Practice Address - Street 1:109 RIVERWAY PL BLDG 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6730
Practice Address - Country:US
Practice Address - Phone:603-262-1424
Practice Address - Fax:603-506-6825
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH056707-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health