Provider Demographics
NPI:1447563275
Name:DAVIS, JESSICA (RN, NP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 BALBOA AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6904
Mailing Address - Country:US
Mailing Address - Phone:858-565-6394
Mailing Address - Fax:858-999-2006
Practice Address - Street 1:5222 BALBOA AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6904
Practice Address - Country:US
Practice Address - Phone:858-565-6394
Practice Address - Fax:858-999-2006
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19909363LF0000X
IL209020876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily