Provider Demographics
NPI:1285935957
Name:URBANO, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:URBANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FORT SANDERS WEST BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3351
Mailing Address - Country:US
Mailing Address - Phone:865-539-2579
Mailing Address - Fax:
Practice Address - Street 1:280 FORT SANDERS WEST BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3351
Practice Address - Country:US
Practice Address - Phone:865-539-0270
Practice Address - Fax:865-539-2579
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine