Provider Demographics
NPI:1679051072
Name:FELICIANO, JESSICA S (BSN, CWSCN, MSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:BSN, CWSCN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7769
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9760
Mailing Address - Country:US
Mailing Address - Phone:939-244-5189
Mailing Address - Fax:
Practice Address - Street 1:70 CALLE 7
Practice Address - Street 2:BO VERDUN
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-9760
Practice Address - Country:US
Practice Address - Phone:939-244-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26842163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice