Provider Demographics
NPI:1316643380
Name:LOGAN, JESSICA L (FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LOGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HAMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1824 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-732-8877
Mailing Address - Fax:
Practice Address - Street 1:1824 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-732-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily