MEDICARE: MRS. JESSICA LYNN DOUGLAS 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	9310684	FL
2	363LF0000X	Family Nurse Practitioner	APRN9310684	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1811376601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LYNN DOUGLAS FNP-BC

Provider Business Mailing Address
First Line	:	104 WOODMONT BLVD STE 500
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2245
Country	:	US
Telephone Number	:	559-475-4151
Fax Number	:	559-421-7004

Provider Business Practice Location Address
First Line	:	289 SW STONEGATE TER STE 103
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3457
Country	:	US
Telephone Number	:	386-755-1655
Fax Number	:	386-628-9231

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	10/14/2024

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