Healthcare Provider Details

I. General information

NPI: 1477476109
Provider Name (Legal Business Name): JESSICA BENZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W FRANKLIN ST
JACKSON MI
49201-2008
US

IV. Provider business mailing address

3857 THORNCREST DR
JACKSON MI
49203-7103
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-3100
  • Fax:
Mailing address:
  • Phone: 517-581-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704321105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: