Healthcare Provider Details

I. General information

NPI: 1306311477
Provider Name (Legal Business Name): JENNIFER ELIZABETH SARGENT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ELIZABETH BENSON

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N LIMESTONE ST STE 175
SPRINGFIELD OH
45503-1114
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
SPRINGFIELD OH
45504-2687
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9980
  • Fax: 937-523-9985
Mailing address:
  • Phone: 937-328-8788
  • Fax: 937-328-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.005697RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005697RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: