Provider Demographics
NPI:1306675475
Name:TRIPLETT, JENNIFER TANABE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TANABE
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 LIBERTY WAY CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4902
Mailing Address - Country:US
Mailing Address - Phone:585-713-2555
Mailing Address - Fax:
Practice Address - Street 1:1331 W GRAND PKWY N STE 210
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:713-575-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical