Provider Demographics
NPI:1114406519
Name:BARRA, JESSICA B (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:BARRA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:B
Other - Last Name:CRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8025 E TUCKEY LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5651
Mailing Address - Country:US
Mailing Address - Phone:480-254-1131
Mailing Address - Fax:
Practice Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1560
Practice Address - Country:US
Practice Address - Phone:772-217-4557
Practice Address - Fax:888-352-7383
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL70363LF0000X
GARN285115363LF0000X
AZAP11576363LF0000X
NM54965363LF0000X
NV819746363LF0000X
WAAP60983710363LF0000X
HIAPRN-2727363LF0000X
WY44356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily