Provider Demographics
NPI:1912374489
Name:HOUGH, JESSICA ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:HOUGH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 RIVERPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9017
Mailing Address - Country:US
Mailing Address - Phone:904-346-0050
Mailing Address - Fax:904-346-0080
Practice Address - Street 1:1510 RIVERPLACE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9017
Practice Address - Country:US
Practice Address - Phone:904-346-0050
Practice Address - Fax:904-346-0080
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9273839363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103564000Medicaid