Provider Demographics
NPI:1811482334
Name:BROSSART, JENNA LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:BROSSART
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2975 HIGHWAY 2 E
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-7801
Mailing Address - Country:US
Mailing Address - Phone:017-765-2167
Mailing Address - Fax:
Practice Address - Street 1:2975 HIGHWAY 2 E
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-7801
Practice Address - Country:US
Practice Address - Phone:701-776-5261
Practice Address - Fax:701-776-5448
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR36696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1475154Medicaid