Provider Demographics
NPI:1144903717
Name:LONGSHORE, JESSICA M (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:LONGSHORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5361 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6014
Mailing Address - Country:US
Mailing Address - Phone:724-312-8667
Mailing Address - Fax:
Practice Address - Street 1:5361 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6014
Practice Address - Country:US
Practice Address - Phone:912-355-8000
Practice Address - Fax:912-355-8403
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN242359363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care