Provider Demographics
NPI:1548802309
Name:TRICE, JAZZMON NICOLE (APRN)
Entity Type:Individual
Prefix:MS
First Name:JAZZMON
Middle Name:NICOLE
Last Name:TRICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 SHADOW VALLEY CV
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1861
Mailing Address - Country:US
Mailing Address - Phone:501-607-3370
Mailing Address - Fax:
Practice Address - Street 1:8400 HIGHWAY 386 EAST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72183
Practice Address - Country:US
Practice Address - Phone:501-897-2982
Practice Address - Fax:501-897-9898
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR122314363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology