Healthcare Provider Details

I. General information

NPI: 1629408760
Provider Name (Legal Business Name): JENNIFER FERNANDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 HIGH ST
HANOVER PA
17331-1127
US

IV. Provider business mailing address

116 S GEORGE ST
YORK PA
17401-1474
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-9052
  • Fax: 717-854-0377
Mailing address:
  • Phone: 717-632-9052
  • Fax: 717-854-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: