Healthcare Provider Details

I. General information

NPI: 1033054622
Provider Name (Legal Business Name): JESSICA SHARP PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

IV. Provider business mailing address

1855 W KATELLA AVE STE 150
ORANGE CA
92867-3432
US

V. Phone/Fax

Practice location:
  • Phone: 714-399-3480
  • Fax: 714-399-3481
Mailing address:
  • Phone: 714-399-3480
  • Fax: 714-399-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95036235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95036234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: