Provider Demographics
NPI:1154605418
Name:HODGES, JENNIFER BARBARA (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BARBARA
Last Name:HODGES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 LAWN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1551
Mailing Address - Country:US
Mailing Address - Phone:215-453-3300
Mailing Address - Fax:215-453-3306
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3300
Practice Address - Fax:215-453-3306
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054956363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical