Healthcare Provider Details

I. General information

NPI: 1639585169
Provider Name (Legal Business Name): JESSICA LEA HAYES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

IV. Provider business mailing address

937 N SPRING GARDEN AVE
DELAND FL
32720-2560
US

V. Phone/Fax

Practice location:
  • Phone: 386-736-1948
  • Fax: 386-736-2784
Mailing address:
  • Phone: 386-736-1948
  • Fax: 386-736-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9175537
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9175537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: