MEDICARE: JESSICA ANDERSON FNP

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	363LF0000X	Family Nurse Practitioner	1045738	TX

General Provider Information

NPI Number	:	1548614340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANDERSON FNP

Provider Business Mailing Address
First Line	:	2200 E BROAD ST STE 100
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6597
Country	:	US
Telephone Number	:	817-473-9473
Fax Number	:	817-473-3473

Provider Business Practice Location Address
First Line	:	2200 E BROAD ST STE 100
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-6597
Country	:	US
Telephone Number	:	817-473-9473
Fax Number	:	817-473-3473

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

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	03/04/2026

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