Provider Demographics
NPI:1538661285
Name:BOGLE, JESSICA MORGAN (FNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:BOGLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MORGAN
Other - Last Name:CAPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:(MAIDEN NAME)
Mailing Address - Street 1:8378 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2018
Mailing Address - Country:US
Mailing Address - Phone:910-526-9945
Mailing Address - Fax:
Practice Address - Street 1:250 PROSPECT PL
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1943
Practice Address - Country:US
Practice Address - Phone:619-522-3722
Practice Address - Fax:619-522-3790
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008709207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services