Individual
JENNA GAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 HIGHWAY 17 N, NORTH MYRTLE BEACH, SC 29582-2806
(336) 259-2495
Mailing address
1010 HIGHWAY 17 N, NORTH MYRTLE BEACH, SC 29582-2806
(843) 249-1451
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
24586
SC
363LF0000X
Family Nurse Practitioner
Primary
24586
SC
Other
Enumeration date
02/01/2021
Last updated
08/17/2021
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