Provider Demographics
NPI:1093944316
Name:GLOVER, JESSICA B (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:GLOVER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WHEELER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5700
Mailing Address - Country:US
Mailing Address - Phone:912-353-7744
Mailing Address - Fax:912-355-9124
Practice Address - Street 1:2 WHEELER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-353-7744
Practice Address - Fax:912-355-9124
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3887363LF0000X
GARN217049363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
203704507OtherTAX ID NUMBER