Provider Demographics
NPI:1891404836
Name:ROGANDO, JESSICA BLANCO (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA BLANCO
Middle Name:
Last Name:ROGANDO
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 1:6030 S RAINBOW BLVD STE D2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2548
Mailing Address - Country:US
Mailing Address - Phone:702-329-0229
Mailing Address - Fax:866-611-3024
Practice Address - Street 1:6030 S RAINBOW BLVD STE D2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2548
Practice Address - Country:US
Practice Address - Phone:702-329-0229
Practice Address - Fax:866-611-3024
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV859027363LF0000X
NVF07220485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF07220485OtherF-NPC