MEDICARE: ALEXANDRA NICOLE JENNINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	31315	SC

General Provider Information

NPI Number	:	1508729328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA NICOLE JENNINGS

Provider Business Mailing Address
First Line	:	305 SALAMANDER CT
Second Line	:
City	:	HUGER
State	:	SC
Zip	:	29450-8504
Country	:	US
Telephone Number	:	203-500-0760
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 WINGO WAY STE 106
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1810
Country	:	US
Telephone Number	:	843-410-0597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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