MEDICARE: JESSICA VIOLA HAMMOND FNP-BC

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
1	163W00000X	Registered Nurse	L1-0037864	DE
2	363LF0000X	Family Nurse Practitioner	LG-0000888	DE
3	363L00000X	Nurse Practitioner	LG-0000888	DE

General Provider Information

NPI Number	:	1447648522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA VIOLA HAMMOND FNP-BC

Provider Business Mailing Address
First Line	:	36450 TIDAL RD UNIT BC
Second Line	:
City	:	SELBYVILLE
State	:	DE
Zip	:	19975-4596
Country	:	US
Telephone Number	:	302-291-6045
Fax Number	:	833-449-3867

Provider Business Practice Location Address
First Line	:	36450 TIDAL RD UNIT BC
Second Line	:
City	:	SELBYVILLE
State	:	DE
Zip	:	19975-4596
Country	:	US
Telephone Number	:	302-291-6045
Fax Number	:	833-449-3867

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2014
Last Update Date	:	10/11/2024

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