Healthcare Provider Details

I. General information

NPI: 1790098788
Provider Name (Legal Business Name): JESSICA FAY OKUN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE # 415C
FT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1625 SE 3RD AVE # 415C
FT LAUDERDALE FL
33316-2521
US

V. Phone/Fax

Practice location:
  • Phone: 954-653-3722
  • Fax:
Mailing address:
  • Phone: 954-653-3722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberOS13918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: