Provider Demographics
NPI:1942301841
Name:IRVIN, JESSICA MERCER (ARNP, CPNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MERCER
Last Name:IRVIN
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CIMAROSA CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5007
Mailing Address - Country:US
Mailing Address - Phone:407-654-1244
Mailing Address - Fax:
Practice Address - Street 1:2100 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5037
Practice Address - Country:US
Practice Address - Phone:407-622-3200
Practice Address - Fax:407-622-3290
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9180163363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics