Provider Demographics
NPI:1568741320
Name:HERRON, JESSICA L (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HERRON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:CASSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:STE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:865-769-3454
Practice Address - Street 1:400 N ASHLEY DR
Practice Address - Street 2:STE 1625
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:865-769-3454
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9224439364SP0808X
FLAPRN9224439363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004012000Medicaid
FL004012000Medicaid