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NPI Code Detail

MEDICARE: JESSICA TRIPP NP

MEDICARE:   JESSICA  TRIPP  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704279373NSA220FRMI

General Provider Information

NPI Number : 1154052330
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA TRIPP NP
Provider Business Mailing Address
First Line : 61 ELDER DR
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-1667
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5087 US HIGHWAY 41 S
Second Line :
City : MARQUETTE
State : MI
Zip : 49855-9001
Country : US
Telephone Number :
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2022
Last Update Date : 06/20/2022

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