Healthcare Provider Details

I. General information

NPI: 1518527654
Provider Name (Legal Business Name): JESSICA LOUISE SELVAGGIO DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 300
RALEIGH NC
27607-6476
US

IV. Provider business mailing address

700 BISHOPS PARK DR UNIT 206
RALEIGH NC
27605-1250
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax:
Mailing address:
  • Phone: 217-416-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number252052
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012107
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: