Provider Demographics
NPI:1114757010
Name:HIRST, JENNA THERESE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:THERESE
Last Name:HIRST
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3004
Mailing Address - Country:US
Mailing Address - Phone:309-781-2643
Mailing Address - Fax:
Practice Address - Street 1:700 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-4317
Practice Address - Country:US
Practice Address - Phone:563-723-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA180607363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner