Healthcare Provider Details

I. General information

NPI: 1598695611
Provider Name (Legal Business Name): JESSICA LYN HERRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 E FLORENCE BLVD
CASA GRANDE AZ
85122
US

IV. Provider business mailing address

1081 W AVALON CANYON DR
CASA GRANDE AZ
85122-6706
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-0380
  • Fax:
Mailing address:
  • Phone: 928-592-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343860
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number343860
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: