Provider Demographics
NPI:1487077434
Name:SCHMITT, JENNA (PA-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11850 BLACKFOOT ST NW STE 130
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2583
Mailing Address - Country:US
Mailing Address - Phone:763-236-2045
Mailing Address - Fax:
Practice Address - Street 1:11850 BLACKFOOT ST NW STE 130
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2583
Practice Address - Country:US
Practice Address - Phone:763-236-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004469363A00000X
MN13585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant