Provider Demographics
NPI:1619423001
Name:DAVIS, JESSICA R (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:GERRIETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:717 N YOUNG
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6530
Mailing Address - Country:US
Mailing Address - Phone:480-246-2656
Mailing Address - Fax:
Practice Address - Street 1:1250 S CLEARVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3378
Practice Address - Country:US
Practice Address - Phone:480-423-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily