Provider Demographics
NPI:1669903159
Name:EZIKA, JESSICA IFEOMA (NP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:IFEOMA
Last Name:EZIKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 VENUE WAY
Mailing Address - Street 2:APT. 7108
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4525
Mailing Address - Country:US
Mailing Address - Phone:215-896-4115
Mailing Address - Fax:
Practice Address - Street 1:700 VENUE WAY
Practice Address - Street 2:APT. 7108
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4525
Practice Address - Country:US
Practice Address - Phone:215-896-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily