Provider Demographics
NPI:1649940271
Name:BROWN, JESSICA M (CPNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 GEORGIAN TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1644
Mailing Address - Country:US
Mailing Address - Phone:732-597-3822
Mailing Address - Fax:
Practice Address - Street 1:1450 GEORGIAN TER
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1644
Practice Address - Country:US
Practice Address - Phone:732-597-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01139500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics