Provider Demographics
NPI:1912443979
Name:REYNOLDS, JENNIFER STILES (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:STILES
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1991 SPROUL RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3512
Mailing Address - Country:US
Mailing Address - Phone:484-426-1669
Mailing Address - Fax:610-886-0164
Practice Address - Street 1:1991 SPROUL RD
Practice Address - Street 2:SUITE 600
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3512
Practice Address - Country:US
Practice Address - Phone:484-426-1669
Practice Address - Fax:610-886-0164
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN601938363L00000X
PASP017213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner