Provider Demographics
NPI:1023627494
Name:MERCHANT, JESSICA (DNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 ALVARADO RD
Mailing Address - Street 2:STE 2308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5241
Mailing Address - Country:US
Mailing Address - Phone:619-462-9010
Mailing Address - Fax:619-287-9058
Practice Address - Street 1:9834 GENESEE AVE STE 412
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1264
Practice Address - Country:US
Practice Address - Phone:858-457-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner