Provider Demographics
NPI:1205451366
Name:WYCKOFF, JESSICA (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12497 TAMIAMI TRL S STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1415
Mailing Address - Country:US
Mailing Address - Phone:941-282-3376
Mailing Address - Fax:941-282-3378
Practice Address - Street 1:12497 TAMIAMI TRL S STE 1
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1415
Practice Address - Country:US
Practice Address - Phone:941-282-3376
Practice Address - Fax:941-282-3378
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2NEDOOtherBCBS