Individual
JESSICA AMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(808) 388-0141
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0097956
OK
363LF0000X
Family Nurse Practitioner
Primary
0003064
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1288023197
DOD ID NUMBER
—
Enumeration date
12/11/2014
Last updated
04/25/2024
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