Provider Demographics
NPI:1922559418
Name:MENDEZ, JESSICA (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2501
Mailing Address - Fax:717-812-2510
Practice Address - Street 1:13515 WOLFE RD
Practice Address - Street 2:STE C
Practice Address - City:NEW FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:17349-9346
Practice Address - Country:US
Practice Address - Phone:717-812-2501
Practice Address - Fax:717-812-2510
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN615531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA554266FLTMedicare PIN