Healthcare Provider Details

I. General information

NPI: 1942021944
Provider Name (Legal Business Name): JENNA JEFFCOAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 W 2ND ST
SWANSEA SC
29160-8665
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-568-2000
  • Fax:
Mailing address:
  • Phone: 803-568-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30056
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number252857
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: