Individual
JESSICA ELIZABETH ALTHIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
927 BROADWAY ST, QUINCY, IL 62301-2719
(217) 228-5535
Mailing address
927 BROADWAY ST, QUINCY, IL 62301-2719
(217) 228-5535
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209.016240
IL
363LF0000X
Family Nurse Practitioner
Primary
277002909
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.385787
REGISTERED PROFESSIONAL NURSE LICENSE NUMBER
IL
01
—
309.011747
ADVANCE PRACTICE CONTROLLED SUBSTANCE LICENSE
IL
01
—
F06170525
AANP CERTIFICATION NUMBER
—
Enumeration date
08/31/2017
Last updated
04/02/2024
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