Healthcare Provider Details

I. General information

NPI: 1053060228
Provider Name (Legal Business Name): JESSICA MARIE SIMMONS-JOSILEVICH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OFFICE PARK DR
JACKSONVILLE NC
28546-3219
US

IV. Provider business mailing address

31 OFFICE PARK DR
JACKSONVILLE NC
28546-3219
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-5016
  • Fax: 910-346-4561
Mailing address:
  • Phone: 910-346-5016
  • Fax: 910-346-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024-01145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: