Healthcare Provider Details

I. General information

NPI: 1023893856
Provider Name (Legal Business Name): JESSICA ZIMMERMAN MSN, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA HARAKIDAS

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 DELMAR AVE
LOOMIS CA
95650-9055
US

IV. Provider business mailing address

PO BOX 2640
CITRUS HEIGHTS CA
95611-2640
US

V. Phone/Fax

Practice location:
  • Phone: 702-606-4225
  • Fax:
Mailing address:
  • Phone: 702-606-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95032829
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: