Healthcare Provider Details

I. General information

NPI: 1285727560
Provider Name (Legal Business Name): TERESA JENKINS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA ELWOOD ANP

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 ERIE BLVD
DEWITT NY
13214-2227
US

IV. Provider business mailing address

304 GENESEE ST
CHITTENANGO NY
13037-1707
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-2244
  • Fax: 315-251-2240
Mailing address:
  • Phone: 315-251-2244
  • Fax: 315-251-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF303187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: