Provider Demographics
NPI:1215435060
Name:EDMONDS, JESSICA RENEE (MSN, APRN, FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:ROBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:369 COLUMBIA AVE APT 417
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1269
Mailing Address - Country:US
Mailing Address - Phone:574-360-2120
Mailing Address - Fax:
Practice Address - Street 1:1100 S COAST HWY STE 214
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2975
Practice Address - Country:US
Practice Address - Phone:949-715-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner