Healthcare Provider Details

I. General information

NPI: 1609493311
Provider Name (Legal Business Name): JESSICA DEANNE YENTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NORTHPORT AVE STE 112
BELFAST ME
04915-6096
US

IV. Provider business mailing address

116 NORTHPORT AVE STE 112
BELFAST ME
04915-6096
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-4163
  • Fax: 207-613-2570
Mailing address:
  • Phone: 207-505-4163
  • Fax: 207-613-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9211
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261329
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28229593A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: