Provider Demographics
NPI:1326460817
Name:LACAYO, JESSICA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LACAYO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4636 RIPLEY MANOR TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1865
Mailing Address - Country:US
Mailing Address - Phone:301-801-1949
Mailing Address - Fax:
Practice Address - Street 1:3350 WORTHINGTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:MD
Practice Address - Zip Code:21704
Practice Address - Country:US
Practice Address - Phone:240-699-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily