Basic Information
| Provider Information | |||||||||
| NPI: | 1972071611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRUNK | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 COLT CV | ||||||||
| Address2: | |||||||||
| City: | MC HENRY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395613702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406321505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15200 COMMUNITY RD | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395033085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285757120 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2018 | ||||||||
| LastUpdateDate: | 01/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 903139 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.