Provider Demographics
NPI:1982062170
Name:DAMICO, JAMIE (AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DAMICO
Suffix:
Gender:F
Credentials:AG-ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 BIENVILLE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5727
Mailing Address - Country:US
Mailing Address - Phone:228-818-9620
Mailing Address - Fax:
Practice Address - Street 1:3603 BIENVILLE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5727
Practice Address - Country:US
Practice Address - Phone:228-818-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901450363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care