Provider Demographics
NPI:1962820209
Name:GUNN, JESSICA ANNE MARIE (APN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE MARIE
Last Name:GUNN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 OHIO TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8931
Mailing Address - Country:US
Mailing Address - Phone:856-308-7975
Mailing Address - Fax:
Practice Address - Street 1:21 OHIO TRL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8931
Practice Address - Country:US
Practice Address - Phone:856-308-7975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR15937400363L00000X
NJ26NJ00490600363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily