Healthcare Provider Details

I. General information

NPI: 1699400986
Provider Name (Legal Business Name): MS. JESSICA LEIGHANNE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 STOCKTON ST
JACKSONVILLE FL
32204-2534
US

IV. Provider business mailing address

13712 FISH EAGLE DR W
JACKSONVILLE FL
32226-5002
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4661
  • Fax: 904-361-5005
Mailing address:
  • Phone: 850-812-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: