Provider Demographics
NPI:1568048445
Name:WIDERMAN, JESSIKA HELENA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:HELENA
Last Name:WIDERMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 S QUENTIN ST STE 50
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4531
Mailing Address - Country:US
Mailing Address - Phone:720-282-2377
Mailing Address - Fax:877-302-5251
Practice Address - Street 1:6500 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-4416
Practice Address - Country:US
Practice Address - Phone:239-533-5770
Practice Address - Fax:844-465-0864
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9337421163WI0500X
NY347118363LF0000X
FLAPRN11012513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy