Provider Demographics
NPI:1104912260
Name:GREENE, JENNIFER P (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:P
Last Name:GREENE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MIDDLE CREEK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5053
Mailing Address - Country:US
Mailing Address - Phone:865-908-9888
Mailing Address - Fax:865-908-8756
Practice Address - Street 1:740 MIDDLE CREEK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5053
Practice Address - Country:US
Practice Address - Phone:865-908-9888
Practice Address - Fax:865-908-8756
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12273363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology