Provider Demographics
NPI:1225477904
Name:TIMMERMAN, JESSICA A (MS-FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:MS-FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:EADICICCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2335
Mailing Address - Country:US
Mailing Address - Phone:732-580-2589
Mailing Address - Fax:
Practice Address - Street 1:4 RYAN RD
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2445
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338012363LF0000X
NJ26NJ00454800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily