Provider Demographics
NPI:1114585940
Name:OLIVER, JESSICA PAIGE (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAIGE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31626-2441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2557 STATE LINE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:GA
Practice Address - Zip Code:31626-2441
Practice Address - Country:US
Practice Address - Phone:850-545-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily