Provider Demographics
NPI:1285972935
Name:POPE, JENNIFER PAULETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PAULETTE
Last Name:POPE
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 1:514 CRAIN HWY N
Mailing Address - Street 2:SUITE K
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3063
Mailing Address - Country:US
Mailing Address - Phone:410-863-4888
Mailing Address - Fax:
Practice Address - Street 1:7948 ANDORICK DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1871
Practice Address - Country:US
Practice Address - Phone:443-599-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily