Provider Demographics
NPI:1417488255
Name:GERARD, JENNIFER (APRN, FNP, IBCLC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GERARD
Suffix:
Gender:
Credentials:APRN, FNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 PELHAM RD
Mailing Address - Street 2:STE 400 #536
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:864-305-3498
Practice Address - Street 1:543 ADALIZ WAY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-7077
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:864-340-3498
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID68047363LF0000X
CO0102781363LF0000X
NM63518363LF0000X
NE113574363LF0000X
FL11013262363LF0000X
IAA162163363LF0000X
TXAP133187363LF0000X
SC26908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily