Provider Demographics
NPI:1245056167
Name:MORAN, JESSICA LYNN (FNP-CB)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:FNP-CB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 E GLENMERE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8936
Mailing Address - Country:US
Mailing Address - Phone:602-710-6894
Mailing Address - Fax:
Practice Address - Street 1:791 E GLENMERE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8936
Practice Address - Country:US
Practice Address - Phone:602-710-6894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN124127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily