Provider Demographics
NPI:1215036868
Name:MELNICOFF, JESSAMYN ANN (CRNP (NURSE PRACT))
Entity Type:Individual
Prefix:MS
First Name:JESSAMYN
Middle Name:ANN
Last Name:MELNICOFF
Suffix:
Gender:F
Credentials:CRNP (NURSE PRACT)
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Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-4600
Mailing Address - Fax:215-707-4034
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-4600
Practice Address - Fax:215-707-4034
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAVP001258C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health