Provider Demographics
NPI:1740663491
Name:MARSHALL-MORENO, JESSICA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:MARSHALL-MORENO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 S STAPLES
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4656
Mailing Address - Country:US
Mailing Address - Phone:361-980-1299
Mailing Address - Fax:361-986-8988
Practice Address - Street 1:14041 NORTHWEST BLVD
Practice Address - Street 2:#1
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5137
Practice Address - Country:US
Practice Address - Phone:361-767-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily