Healthcare Provider Details

I. General information

NPI: 1275248809
Provider Name (Legal Business Name): JENNA BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA JACOBS PA-C

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 NORTHWOODS BLVD STE C2
COLUMBUS OH
43235-4720
US

IV. Provider business mailing address

92 NORTHWOODS BLVD STE C2
COLUMBUS OH
43235-4720
US

V. Phone/Fax

Practice location:
  • Phone: 614-841-9763
  • Fax:
Mailing address:
  • Phone: 614-841-9763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.007940RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: