Provider Demographics
NPI:1417829714
Name:CHURCHILL, JANA LEE (AGNP-C)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LEE
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 BETHLEHEM PIKE FL 1
Mailing Address - Street 2:
Mailing Address - City:ERDENHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:19038-7731
Mailing Address - Country:US
Mailing Address - Phone:215-248-1350
Mailing Address - Fax:
Practice Address - Street 1:906 BETHLEHEM PIKE FL 1
Practice Address - Street 2:
Practice Address - City:ERDENHEIM
Practice Address - State:PA
Practice Address - Zip Code:19038-7731
Practice Address - Country:US
Practice Address - Phone:215-248-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP033621363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health