Healthcare Provider Details

I. General information

NPI: 1184086761
Provider Name (Legal Business Name): JESSICA FREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-2049
US

IV. Provider business mailing address

3450 HULL RD
GAINESVILLE FL
32607-4144
US

V. Phone/Fax

Practice location:
  • Phone: 352-294-5400
  • Fax: 352-294-5399
Mailing address:
  • Phone: 352-294-5400
  • Fax: 352-294-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number29286419
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME147045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: