Provider Demographics
NPI:1851606487
Name:ROSS, JESSICA (RN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 242
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE 242
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2542
Practice Address - Country:US
Practice Address - Phone:404-727-3236
Practice Address - Fax:404-778-7645
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210831363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care