Provider Demographics
NPI:1588031728
Name:BRUBAKER, JESSICA M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Mailing Address - Street 1:1535 HIGHLANDS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7681
Mailing Address - Country:US
Mailing Address - Phone:717-625-3509
Mailing Address - Fax:717-625-4258
Practice Address - Street 1:1535 HIGHLANDS DR STE 300
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7681
Practice Address - Country:US
Practice Address - Phone:717-625-3509
Practice Address - Fax:717-625-4258
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP015064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner