Healthcare Provider Details

I. General information

NPI: 1548105059
Provider Name (Legal Business Name): JESSICA AMBROISE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA SANON PMHNP-BC

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9098 PARAGON WAY
BOYNTON BEACH FL
33472-5112
US

IV. Provider business mailing address

9098 PARAGON WAY
BOYNTON BEACH FL
33472-5112
US

V. Phone/Fax

Practice location:
  • Phone: 786-835-6877
  • Fax:
Mailing address:
  • Phone: 786-835-6877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN9523181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: