MEDICARE: JESSICA HINTON VINCENT DNP, ACNP-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	363LC0200X	Critical Care Medicine Nurse Practitioner	RN187984	GA
2	363LA2100X	Acute Care Nurse Practitioner	RN187984	GA

General Provider Information

NPI Number	:	1497185441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HINTON VINCENT DNP, ACNP-BC

Provider Business Mailing Address
First Line	:	80 JESSE HILL JR DR SE FL 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3031
Country	:	US
Telephone Number	:	404-616-7309
Fax Number	:

Provider Business Practice Location Address
First Line	:	9202 HIGHWAY 278 NE STE 100E
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-7011
Country	:	US
Telephone Number	:	678-342-8677
Fax Number	:

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

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	10/02/2024

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