Provider Demographics
NPI:1013787324
Name:HENRIQUES, JESSICA A (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:HENRIQUES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COUNTY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1652
Mailing Address - Country:US
Mailing Address - Phone:508-264-0144
Mailing Address - Fax:
Practice Address - Street 1:55 COUNTY RD STE 2
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1652
Practice Address - Country:US
Practice Address - Phone:508-264-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2317616363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health