Provider Demographics
NPI:1073972279
Name:LORENZO, JESSICA LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:LORENZO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:340 OXFORD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1965
Mailing Address - Country:US
Mailing Address - Phone:740-622-3016
Mailing Address - Fax:
Practice Address - Street 1:1523 WALNUT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2289
Practice Address - Country:US
Practice Address - Phone:740-622-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161967Medicaid
OHH447140OtherMEDICARE PTAN