Provider Demographics
NPI:1730517111
Name:FITZSIMMONS, JENNIFER ECKENRODE (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ECKENRODE
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5157 BUSINESS 220 STE 1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-7770
Mailing Address - Country:US
Mailing Address - Phone:814-623-8414
Mailing Address - Fax:814-623-6668
Practice Address - Street 1:5157 BUSINESS 220 STE 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-7770
Practice Address - Country:US
Practice Address - Phone:814-623-8414
Practice Address - Fax:814-623-6668
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200178363LF0000X
PASP016704363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211809OtherMEDICARE FQHC
MD211828OtherMEDICARE FQHC