Healthcare Provider Details

I. General information

NPI: 1841885118
Provider Name (Legal Business Name): JESSICA RASSAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5440
US

IV. Provider business mailing address

4742 E INDIAN SCHOOL RD
PHOENIX AZ
85018-5440
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-2950
  • Fax:
Mailing address:
  • Phone: 602-840-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN163765
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number257617
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number257617
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: