Provider Demographics
NPI:1063760577
Name:JERNIGAN, JOLENE CROUCH (FNP)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:CROUCH
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JOLENE
Other - Middle Name:C
Other - Last Name:JERNIGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1000 E FIFTH ST
Mailing Address - Street 2:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-2502
Mailing Address - Country:US
Mailing Address - Phone:252-737-2615
Mailing Address - Fax:252-328-4007
Practice Address - Street 1:1000 E FIFTH ST
Practice Address - Street 2:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2502
Practice Address - Country:US
Practice Address - Phone:252-737-2615
Practice Address - Fax:252-328-4007
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily