Provider Demographics
NPI:1417028655
Name:PESCE, JODI MARIE (RN-C,MSN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:PESCE
Suffix:
Gender:F
Credentials:RN-C,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6097
Mailing Address - Country:US
Mailing Address - Phone:770-957-1887
Mailing Address - Fax:770-957-6864
Practice Address - Street 1:50 KELLY RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6097
Practice Address - Country:US
Practice Address - Phone:770-957-1887
Practice Address - Fax:770-957-6864
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097976 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily