Provider Demographics
NPI:1720376940
Name:TEDDER, JESSICA MARIE HAMILTON (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE HAMILTON
Last Name:TEDDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2100 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4704
Mailing Address - Country:US
Mailing Address - Phone:772-460-0321
Mailing Address - Fax:772-460-0332
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4704
Practice Address - Country:US
Practice Address - Phone:772-460-0321
Practice Address - Fax:772-460-0332
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9266036363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics