Healthcare Provider Details

I. General information

NPI: 1881489680
Provider Name (Legal Business Name): JESNASUBLETT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 ORANGE CAMP RD STE 115
DELAND FL
32724-7770
US

IV. Provider business mailing address

1431 ORANGE CAMP RD STE 115
DELAND FL
32724-7770
US

V. Phone/Fax

Practice location:
  • Phone: 386-222-2792
  • Fax: 386-478-4905
Mailing address:
  • Phone: 386-222-2792
  • Fax: 386-478-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESNA SUSAN MATHEW SUBLETT
Title or Position: OWNER
Credential: MBBS
Phone: 386-222-2792