| Doctor Name: | JESSICA JO TACKE-HANSON |
| NPI Number: | 1548466477 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 200650066NP |
| Business Practice Address: | 2305 Se Washington St Ste 105 Milwaukie, OR - 972227647 |
| Business Phone Number: | 5036571255 |
| Business Fax Number: | |
| Mailing Address: | 13826 Meyers Rd Apt 2067, OREGON CITY |
| State: | OR |
| Postal Code: | 970457960 |
| Phone Number: | 5037239439 |
| Fax Number: | |
| NPI Enumeration Date: | 06/26/2007 |
| NPI Last Update Date: | 09/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200650066NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |