Provider Demographics
NPI:1235608258
Name:MACKIN, JESSICA ARCE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ARCE
Last Name:MACKIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:ARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:55 FRUIT STREET
Mailing Address - Street 2:BLAKE 12 ICU
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-643-0337
Mailing Address - Fax:617-726-7560
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-643-0337
Practice Address - Fax:617-726-7560
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306037363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health