Provider Demographics
NPI:1902172380
Name:JANNOTTI, JENNIFER M (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:JANNOTTI
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 1:95 LEONARD AVE
Mailing Address - Street 2:BUILDING 1, SUITE 202
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-206-0610
Mailing Address - Fax:
Practice Address - Street 1:95 LEONARD AVE
Practice Address - Street 2:BUILDING 1, SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-206-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1099074OtherNCCPA ID