Healthcare Provider Details

I. General information

NPI: 1295551919
Provider Name (Legal Business Name): JENNIFER NOELLE FLYNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 VINEYARD WAY STE 501
WEST GROVE PA
19390-8836
US

IV. Provider business mailing address

260 BETHEL RD
OXFORD PA
19363-1164
US

V. Phone/Fax

Practice location:
  • Phone: 610-806-5450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN742405
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0012979
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP030649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: