Provider Demographics
NPI:1821012923
Name:JARIS-WEAVER, JENNIFER ELIZABETH (APN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:JARIS-WEAVER
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BRIARVILLE RD BLDG F
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5136
Mailing Address - Country:US
Mailing Address - Phone:615-860-0704
Mailing Address - Fax:615-860-9882
Practice Address - Street 1:1210 BRIARVILLE RD BLDG F
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5136
Practice Address - Country:US
Practice Address - Phone:615-860-0704
Practice Address - Fax:615-860-9882
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4012290363LF0000X
TN7552363LF0000X
WV118341363LF0000X
NH092848363LF0000X
ME231632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3906171Medicare PIN
TN4091143OtherBLUE CROSS BLUE SHIELD
TNP04103Medicare UPIN