Provider Demographics
NPI:1811376601
Name:DOUGLAS, JESSICA LYNN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:FNP-BC
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Mailing Address - Street 1:104 WOODMONT BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2245
Mailing Address - Country:US
Mailing Address - Phone:559-475-4151
Mailing Address - Fax:559-421-7004
Practice Address - Street 1:289 SW STONEGATE TER STE 103
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3457
Practice Address - Country:US
Practice Address - Phone:386-755-1655
Practice Address - Fax:386-628-9231
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2024-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9310684163W00000X
FLAPRN9310684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse