Provider Demographics
NPI:1699416974
Name:DANIELS, JESSICA MARIE (CNP, APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:CNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FREDERIC CT
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-5500
Mailing Address - Country:US
Mailing Address - Phone:515-447-1568
Mailing Address - Fax:
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2736
Practice Address - Country:US
Practice Address - Phone:320-252-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF02220290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner