Healthcare Provider Details

I. General information

NPI: 1710113337
Provider Name (Legal Business Name): JESSICA ALLEN CHING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0138
US

IV. Provider business mailing address

PO BOX 100108 J402
GAINESVILLE FL
32610-0138
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8670
  • Fax: 352-273-8639
Mailing address:
  • Phone: 352-273-8670
  • Fax: 352-273-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME111226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: