Provider Demographics
NPI:1053735647
Name:YEAGER, JENNA (PA-C, ATC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:YEAGER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3536
Mailing Address - Country:US
Mailing Address - Phone:419-473-9500
Mailing Address - Fax:419-473-9501
Practice Address - Street 1:7640 SYLVANIA AVE STE B
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9263
Practice Address - Country:US
Practice Address - Phone:419-517-8178
Practice Address - Fax:419-517-8188
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004005363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical