Provider Demographics
NPI:1144742925
Name:GREER, JESSICA ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:GREER
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 1:1138 N ALMA SCHOOL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3003
Mailing Address - Country:US
Mailing Address - Phone:888-381-4858
Mailing Address - Fax:
Practice Address - Street 1:1138 N ALMA SCHOOL RD STE 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:888-381-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156197163W00000X
AZAP11017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN156197OtherNURSING LICENSE
AZAP11017Medicaid
AZAP11017OtherADVANCE NURSE PRACTITIONER LICENSE