Provider Demographics
NPI:1811643422
Name:PEAN-WINSTON, JENNIFER CHARLENE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHARLENE
Last Name:PEAN-WINSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHARLENE
Other - Last Name:PEAN-WINSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3685 WARWICK WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8069
Mailing Address - Country:US
Mailing Address - Phone:404-409-9439
Mailing Address - Fax:
Practice Address - Street 1:295 W PIKE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4877
Practice Address - Country:US
Practice Address - Phone:404-409-9439
Practice Address - Fax:678-580-0268
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF02220878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily