MEDICARE: MS. MARY PAMELA JENNINGS CRNP, FNP/GNP-BC

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	363LF0000X	Family Nurse Practitioner	TPAN2027	FL
2	363LF0000X	Family Nurse Practitioner	1-080489	AL

General Provider Information

NPI Number	:	1891779294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY PAMELA JENNINGS CRNP, FNP/GNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 211699
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55121-3699
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:	888-973-8821

Provider Business Practice Location Address
First Line	:	1 PERIMETER PARK S STE 195A
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2327
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:	888-973-8821

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	01/09/2024

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