MEDICARE: JESSY J CRANIAL PROSTHETICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396607073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSY J CRANIAL PROSTHETICS INC

Provider Business Mailing Address
First Line	:	5005 W LAUREL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3886
Country	:	US
Telephone Number	:	888-641-7251
Fax Number	:	813-560-4201

Provider Business Practice Location Address
First Line	:	5005 W LAUREL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3886
Country	:	US
Telephone Number	:	888-641-7251
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANELLE JOHN
Credential	:
Telephone Number	:	813-369-2561

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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