Basic Information
| Provider Information | |||||||||
| NPI: | 1053738625 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOURGEOIS | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1431 CENTERPOINT BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379321984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659857024 | ||||||||
| FaxNumber: | 8659857077 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 45TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618846300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN9265203 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 390200000X | RN9265203 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.