Provider Demographics
NPI:1548505779
Name:WATTOFF, JENNIFER ANN (ANP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WATTOFF
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6218 S LEWIS AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1018
Mailing Address - Country:US
Mailing Address - Phone:918-743-5067
Mailing Address - Fax:
Practice Address - Street 1:6218 S LEWIS AVE
Practice Address - Street 2:STE 110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1018
Practice Address - Country:US
Practice Address - Phone:918-743-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner