Provider Demographics
NPI:1164046652
Name:HELLMAN, JESSICA MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:HELLMAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29130-7100
Mailing Address - Country:US
Mailing Address - Phone:803-479-5289
Mailing Address - Fax:
Practice Address - Street 1:213 TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:SC
Practice Address - Zip Code:29130-7100
Practice Address - Country:US
Practice Address - Phone:803-337-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily