Provider Demographics
NPI:1861798399
Name:MCNICHOLL, JENNA LYNN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LYNN
Last Name:MCNICHOLL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:BAUMGARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1418 NEW RD STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1179
Mailing Address - Country:US
Mailing Address - Phone:609-796-2119
Mailing Address - Fax:
Practice Address - Street 1:1418 NEW RD STE 1
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1179
Practice Address - Country:US
Practice Address - Phone:609-796-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00253100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical