Healthcare Provider Details

I. General information

NPI: 1881364735
Provider Name (Legal Business Name): JESSICA ULYSSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

12208 N ARMENIA AVE
TAMPA FL
33612-5040
US

V. Phone/Fax

Practice location:
  • Phone: 352-627-9350
  • Fax: 352-273-9054
Mailing address:
  • Phone: 786-309-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11015415
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202018110
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11015415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: