Provider Demographics
NPI:1649750092
Name:MURILLO, JESSICA LEE (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MURILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-3239
Mailing Address - Country:US
Mailing Address - Phone:682-561-5605
Mailing Address - Fax:
Practice Address - Street 1:1105 TYLER ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-3239
Practice Address - Country:US
Practice Address - Phone:682-561-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse