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General NPI Number Information
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NPI Number | 1104393180
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Entity Type | Individual
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Provider Name | JENNA NICOLE SARNA NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 400 S KENNEDY DR STE 700
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City | BRADLEY
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State | IL
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Zip | 60915-2639
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Country | US
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Telephone | 815-935-7532
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Fax | 815-935-7495
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Provider Business Mailing Address
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Address Line | 631 HAWTHORNE DR
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City | FRANKFORT
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State | IL
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Zip | 60423-9517
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Country | US
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Telephone | 708-257-4450
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209018251
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License Number State | IL
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