Healthcare Provider Details

I. General information

NPI: 1558965004
Provider Name (Legal Business Name): JENNIFER A JARESS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

9732 MORNINGVIEW CIR
PERRY HALL MD
21128-9024
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-5538
  • Fax:
Mailing address:
  • Phone: 904-571-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR269975
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9375748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: