Healthcare Provider Details

I. General information

NPI: 1184123473
Provider Name (Legal Business Name): BROOKE JENNINGS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ASHLAND AVE
ZANESVILLE OH
43701-2806
US

IV. Provider business mailing address

1320 WEST MAIN ST
NEWARK OH
43055
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-8551
  • Fax: 740-454-2411
Mailing address:
  • Phone: 220-564-4027
  • Fax: 220-564-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number022297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: