Provider Demographics
NPI:1407589245
Name:NAMBURI, JESSICA SHAY PALMER (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:SHAY PALMER
Last Name:NAMBURI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2601
Mailing Address - Country:US
Mailing Address - Phone:814-384-9188
Mailing Address - Fax:
Practice Address - Street 1:702 1ST AVE N
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-2601
Practice Address - Country:US
Practice Address - Phone:814-384-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020597363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner