Provider Demographics
NPI:1932174133
Name:FLINN, JENNIFER G (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:FLINN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 W LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1007
Mailing Address - Country:US
Mailing Address - Phone:217-243-7200
Mailing Address - Fax:217-243-6165
Practice Address - Street 1:1602 W LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1007
Practice Address - Country:US
Practice Address - Phone:217-243-7200
Practice Address - Fax:217-243-6165
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97170Medicare ID - Type Unspecified
P36742Medicare UPIN