Provider Demographics
NPI:1215603972
Name:PERICLES, JESSICA R (MSN ARNP FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:PERICLES
Suffix:
Gender:F
Credentials:MSN ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7859 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-3225
Mailing Address - Country:US
Mailing Address - Phone:954-394-0350
Mailing Address - Fax:
Practice Address - Street 1:2720 SOMERSET DR APT W306
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-9414
Practice Address - Country:US
Practice Address - Phone:954-394-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily