MEDICARE: JESSICA RASSAS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	C-APN.0105808-C-NP	CO
2	363LP2300X	Primary Care Nurse Practitioner	257617	AZ
3	363LF0000X	Family Nurse Practitioner	APRN-5670	HI
4	363LF0000X	Family Nurse Practitioner	N370083039	WA
5	363LF0000X	Family Nurse Practitioner	257617	AZ
6	163WG0000X	General Practice Registered Nurse	RN163765	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN163765	OTHER	AZ	AZBN
2	257617	OTHER	AZ	ARIZONA STATE BOARD OF NURSING

General Provider Information

NPI Number	:	1841885118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RASSAS APRN

Provider Business Mailing Address
First Line	:	4742 E INDIAN SCHOOL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-5440
Country	:	US
Telephone Number	:	602-840-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 CROSSINGS DR STE 206
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-7101
Country	:	US
Telephone Number	:	866-849-0692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	02/05/2026

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Directions to “ JESSICA RASSAS APRN” Practice Location

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