Provider Demographics
NPI:1851833263
Name:HALLORAN, JESSICA C (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:C
Other - Last Name:BALTZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8200
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:717-741-3043
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:717-741-3043
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016447363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner