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NPI Code Detail

MEDICARE: MS. JESSICA NICOLE COLLERA MSN, APRN, AGPCNP

MEDICARE: MS. JESSICA NICOLE COLLERA MSN, APRN, AGPCNP
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
1363L00000XNurse PractitionerAPRN11008595FL
2363LA2200XAdult Health Nurse PractitionerAPRN11008595FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111008595OTHERFLAPRN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720699671
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA NICOLE COLLERA MSN, APRN, AGPCNP
Provider Business Mailing Address
First Line : PO BOX 198441
Second Line :
City : ATLANTA
State : GA
Zip : 30384-8441
Country : US
Telephone Number : 813-745-4673
Fax Number :
Provider Business Practice Location Address
First Line : 12902 USF MAGNOLIA DR
Second Line :
City : TAMPA
State : FL
Zip : 33612-9416
Country : US
Telephone Number : 813-745-4673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 03/06/2026

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