Provider Demographics
NPI:1962167577
Name:MARTIN, JENNA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:MARTIN
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 1:1142 APPENZELLER AVE
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2917
Mailing Address - Country:US
Mailing Address - Phone:484-903-3155
Mailing Address - Fax:
Practice Address - Street 1:238 SPRING ST STE A
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2115
Practice Address - Country:US
Practice Address - Phone:973-862-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant