Provider Demographics
NPI:1770944571
Name:DUFFIN, JESSICA (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DUFFIN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17333 LA GRANGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7510
Mailing Address - Country:US
Mailing Address - Phone:708-342-1900
Mailing Address - Fax:708-745-9993
Practice Address - Street 1:17333 LA GRANGE RD STE 200
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7510
Practice Address - Country:US
Practice Address - Phone:708-342-1900
Practice Address - Fax:708-745-9993
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily