Provider Demographics
NPI:1073155719
Name:DINE, JESSICA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DINE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BEVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,FNP-BC
Mailing Address - Street 1:7104 NEW SANGER AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3928
Mailing Address - Country:US
Mailing Address - Phone:254-262-3188
Mailing Address - Fax:254-224-6583
Practice Address - Street 1:7104 NEW SANGER AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3928
Practice Address - Country:US
Practice Address - Phone:254-262-3188
Practice Address - Fax:254-224-6583
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily