Provider Demographics
NPI:1639914542
Name:BRANOWER, JESSICA MARIE AZCARATE (MSM, MMS, PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE AZCARATE
Last Name:BRANOWER
Suffix:
Gender:F
Credentials:MSM, MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PENNINGTON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-8666
Mailing Address - Country:US
Mailing Address - Phone:571-594-8120
Mailing Address - Fax:
Practice Address - Street 1:615 PENNINGTON RIDGE CT
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-8666
Practice Address - Country:US
Practice Address - Phone:571-594-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant