Healthcare Provider Details

I. General information

NPI: 1225800113
Provider Name (Legal Business Name): JENNA GRACE ESPOSITO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 FIRETHORN DR
PERKASIE PA
18944-4529
US

IV. Provider business mailing address

29 FIRETHORN DR
PERKASIE PA
18944-4529
US

V. Phone/Fax

Practice location:
  • Phone: 267-377-7561
  • Fax:
Mailing address:
  • Phone: 267-377-7561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028491
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: