Provider Demographics
NPI:1861821217
Name:MURRELL THOMAS, JESSICA RYAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RYAN
Last Name:MURRELL THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:RYAN
Other - Last Name:MACCARTNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:654 NW RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3169
Mailing Address - Country:US
Mailing Address - Phone:386-288-0252
Mailing Address - Fax:
Practice Address - Street 1:654 NW RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3169
Practice Address - Country:US
Practice Address - Phone:386-288-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5208251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse