Provider Demographics
NPI:1689989683
Name:CO, JESSICA L (MSN, APRN, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CO
Suffix:
Gender:F
Credentials:MSN, APRN, RN
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Other - Middle Name:
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Mailing Address - Street 1:2900 CORPORATE WAY # WAYD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5603
Mailing Address - Fax:
Practice Address - Street 1:5647 HOLLYWOOD BLVD STE 390
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6325
Practice Address - Country:US
Practice Address - Phone:954-265-7450
Practice Address - Fax:954-265-7469
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009141363LF0000X
OH11738363LF0000X
OHCOA.11738-NP363LP0200X
FL11009975204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics