Provider Demographics
NPI:1417337908
Name:GOULART, JESSICA MONIZ (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MONIZ
Last Name:GOULART
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:MONIZ
Other - Last Name:RAMALHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 NORTH AVE OFC 18
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1306
Mailing Address - Country:US
Mailing Address - Phone:781-705-0567
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVE OFC 18
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1306
Practice Address - Country:US
Practice Address - Phone:781-705-0567
Practice Address - Fax:623-666-6792
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN110253162084P0804X
MARN2290970363LF0000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily