Provider Demographics
NPI:1265809651
Name:SOBOLIK, JENNIFER ANNE (CNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:SOBOLIK
Suffix:
Gender:F
Credentials:CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 OLD HILL CITY RD
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-6603
Mailing Address - Country:US
Mailing Address - Phone:605-941-9549
Mailing Address - Fax:
Practice Address - Street 1:350 PINE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1669
Practice Address - Country:US
Practice Address - Phone:605-721-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000983363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily