Provider Demographics
NPI:1053111930
Name:SIMPSON, JALISA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:JALISA
Middle Name:MARIE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67537
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8009
Mailing Address - Country:US
Mailing Address - Phone:302-400-9999
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 303
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2135
Practice Address - Country:US
Practice Address - Phone:302-400-9999
Practice Address - Fax:302-600-3589
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF12240720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily