Individual
JESSICA DIANE MEMBRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
145 RIVERSTONE TER STE 101, CANTON, GA 30114-5327
(770) 450-4807
Mailing address
606 FOREST PINE DR, BALL GROUND, GA 30107-5196
(770) 608-4407
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN259993
GA
363L00000X
Nurse Practitioner
Primary
RN259993
GA
Other
Enumeration date
01/17/2022
Last updated
10/09/2025
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