Healthcare Provider Details

I. General information

NPI: 1326985763
Provider Name (Legal Business Name): JESSICA PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S 23RD ST
FORT PIERCE FL
34950-4803
US

IV. Provider business mailing address

3301 SW DUNKLIN AVE
OKEECHOBEE FL
34974-2148
US

V. Phone/Fax

Practice location:
  • Phone: 772-353-0024
  • Fax:
Mailing address:
  • Phone: 772-353-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: