Healthcare Provider Details

I. General information

NPI: 1679362156
Provider Name (Legal Business Name): JESSICA ANN GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3307
US

IV. Provider business mailing address

7704 SANTA LUCIA ST NW
ALBUQUERQUE NM
87120-3656
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-8800
  • Fax:
Mailing address:
  • Phone: 505-972-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60467
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: