Provider Demographics
NPI:1033475892
Name:BASS, JESSICA LOUISE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOUISE
Last Name:BASS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LOUISE
Other - Last Name:BROWNLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15250 107TH ST
Mailing Address - Street 2:
Mailing Address - City:FELLSMERE
Mailing Address - State:FL
Mailing Address - Zip Code:32948-7524
Mailing Address - Country:US
Mailing Address - Phone:321-544-5114
Mailing Address - Fax:888-352-7383
Practice Address - Street 1:14355 MIRANDA WAY
Practice Address - Street 2:
Practice Address - City:LOS ALTOS HILLS
Practice Address - State:CA
Practice Address - Zip Code:94022-2032
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:888-732-8119
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9263858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008761600Medicaid