Healthcare Provider Details

I. General information

NPI: 1568078376
Provider Name (Legal Business Name): JENNIFER PRENDERGAST APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 OHIO PIKE
CINCINNATI OH
45245-2131
US

IV. Provider business mailing address

505 CORPORATE CENTER DR UNIT A
VANDALIA OH
45377-1168
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9700
  • Fax: 513-852-8966
Mailing address:
  • Phone: 937-898-2098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027542
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: