Provider Demographics
NPI:1366712960
Name:SYNNAMON, JENNA LAUREN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:LAUREN
Last Name:SYNNAMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:484-526-7555
Mailing Address - Fax:484-526-7556
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 502
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-7555
Practice Address - Fax:484-526-7556
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA 055270363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical