| Doctor Name: | JESSICA CARRASQUILLO |
| NPI Number: | 1114368131 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-NP |
| License Number: | 111531 |
| Business Practice Address: | 3911 Avenue B Ste 2100 Scottsbluff, NE - 693614617 |
| Business Phone Number: | 3086302920 |
| Business Fax Number: | 3086301890 |
| Mailing Address: | 3911 Avenue B Ste 2100, SCOTTSBLUFF |
| State: | NE |
| Postal Code: | 693614617 |
| Phone Number: | 3086302920 |
| Fax Number: | 3086301890 |
| NPI Enumeration Date: | 07/08/2013 |
| NPI Last Update Date: | 11/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 111531 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |