Healthcare Provider Details

I. General information

NPI: 1053457739
Provider Name (Legal Business Name): JESSICA LEIGH STEVENSON L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 100294
GAINESVILLE FL
32610-2944
US

IV. Provider business mailing address

411 NW 3RD ST
GAINESVILLE FL
32601-5261
US

V. Phone/Fax

Practice location:
  • Phone: 352-278-1007
  • Fax:
Mailing address:
  • Phone: 352-278-1007
  • Fax: 386-462-9021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW171
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11038195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: