Provider Demographics
NPI:1285344523
Name:DONOVAN, JESSICA R (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 MATTSON HTS
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2810
Mailing Address - Country:US
Mailing Address - Phone:207-554-0741
Mailing Address - Fax:
Practice Address - Street 1:12 SCHUMAN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0433
Practice Address - Country:US
Practice Address - Phone:207-307-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECNP221637OtherMAINE STATE BOARD OF NURSING