Provider Demographics
NPI:1154003614
Name:FRENTZOS, JAN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:FRENTZOS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 AMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-8536
Mailing Address - Country:US
Mailing Address - Phone:931-436-7774
Mailing Address - Fax:
Practice Address - Street 1:1377 AMBLESIDE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-8536
Practice Address - Country:US
Practice Address - Phone:931-436-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-111018163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant