Provider Demographics
NPI:1922780170
Name:WARE, JESSICA NICOLE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:WARE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8470
Mailing Address - Country:US
Mailing Address - Phone:480-296-6196
Mailing Address - Fax:
Practice Address - Street 1:13838 S 46TH PL STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7802
Practice Address - Country:US
Practice Address - Phone:480-783-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ286382363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty