Provider Demographics
NPI:1619400744
Name:BITENCOURT, JESSICA COLLEEN GARCIA (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:COLLEEN GARCIA
Last Name:BITENCOURT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:COLLEEN MOREIRA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2929
Mailing Address - Country:US
Mailing Address - Phone:252-492-3152
Mailing Address - Fax:252-430-1928
Practice Address - Street 1:480 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2929
Practice Address - Country:US
Practice Address - Phone:252-492-3152
Practice Address - Fax:252-430-1928
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227816390200000X
NC01676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program