Healthcare Provider Details

I. General information

NPI: 1417337908
Provider Name (Legal Business Name): JESSICA MONIZ GOULART FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JESSICA MONIZ RAMALHO

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 NORTH AVE OFC 18
WAKEFIELD MA
01880-1306
US

IV. Provider business mailing address

607 NORTH AVE OFC 18
WAKEFIELD MA
01880-1306
US

V. Phone/Fax

Practice location:
  • Phone: 781-705-0567
  • Fax: 623-666-6792
Mailing address:
  • Phone: 781-705-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberAPRN11025316
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2290970
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN2290970
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: