Provider Demographics
NPI:1528557485
Name:MADRID-WARDEN, JESSICA M (NP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:MADRID-WARDEN
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1716 E SKYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2013
Mailing Address - Country:US
Mailing Address - Phone:928-812-2859
Mailing Address - Fax:
Practice Address - Street 1:103 MEDICINE WAY ROAD
Practice Address - Street 2:
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily