Provider Demographics
NPI:1477330744
Name:PISCOPO, JENESSA LUCIA (APN)
Entity Type:Individual
Prefix:MS
First Name:JENESSA
Middle Name:LUCIA
Last Name:PISCOPO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TRAILSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2854
Mailing Address - Country:US
Mailing Address - Phone:847-946-3483
Mailing Address - Fax:
Practice Address - Street 1:450 TRAILSIDE DR
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2854
Practice Address - Country:US
Practice Address - Phone:847-946-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily