MEDICARE: JENNA ROSE STODDARD FNP

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	207Q00000X	Family Medicine Physician	4704330253	MI
2	363LF0000X	Family Nurse Practitioner	4704330253	MI

General Provider Information

NPI Number	:	1790549327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ROSE STODDARD FNP

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2345
Country	:	US
Telephone Number	:	231-935-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 PARK FOREST DR STE 200
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-7306
Country	:	US
Telephone Number	:	231-600-7466
Fax Number	:	877-370-4631

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

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	05/28/2026

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Directions to “ JENNA ROSE STODDARD FNP” Practice Location

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