Provider Demographics
NPI:1235608258
Name:MACKIN, JESSICA ARCE (CNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ARCE
Last Name:MACKIN
Suffix:
Gender:
Credentials:CNP
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:ARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:CHURCHILL SURGICAL SERVICE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-2760
Mailing Address - Fax:617-724-0405
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2760
Practice Address - Fax:617-724-0405
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306037363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner