Healthcare Provider Details

I. General information

NPI: 1215582549
Provider Name (Legal Business Name): JESSICA MARIE ROJAS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MARIE GRUWELL

II. Dates (important events)

Enumeration Date: 08/04/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 CONSTITUTION PL NE STE 202
ALBUQUERQUE NM
87110-7640
US

IV. Provider business mailing address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-3096
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number57122
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP95035002
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number57122
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: