Provider Demographics
NPI:1902573363
Name:JAMMOUL, JENNA LINDSAY (RN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LINDSAY
Last Name:JAMMOUL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23776G W CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-8808
Mailing Address - Country:US
Mailing Address - Phone:678-488-1898
Mailing Address - Fax:
Practice Address - Street 1:23776G W CYPRESS WAY
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-8808
Practice Address - Country:US
Practice Address - Phone:678-488-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220735163W00000X
FLAPRN11018250367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse