Healthcare Provider Details

I. General information

NPI: 1205293958
Provider Name (Legal Business Name): JENNIFER ROSBOROUGH PORTER NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

ATTN. MANAGED CARE PLANNING PO BOX 40908
FAYETTEVILLE NC
28309
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-6762
  • Fax:
Mailing address:
  • Phone: 910-615-6949
  • Fax: 910-615-9761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number5006870
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5006870
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: