Healthcare Provider Details

I. General information

NPI: 1043999022
Provider Name (Legal Business Name): JESSICA STASINSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

3660 N LAKE SHORE DR APT 3611
CHICAGO IL
60613-5316
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-3095
  • Fax:
Mailing address:
  • Phone: 224-245-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041428791
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11029199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: