Healthcare Provider Details

I. General information

NPI: 1962584433
Provider Name (Legal Business Name): JESSICA IVETTE WARTHEN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOLUEVARD DEPARTMENT OF VETERANS AFFAIRS; MENTAL HEALTH CLINIC
JACKSONVILLE FL
32206
US

IV. Provider business mailing address

3028 W GINGER CT
JACKSONVILLE FL
32259-4560
US

V. Phone/Fax

Practice location:
  • Phone: 904-232-2751
  • Fax: 904-232-1570
Mailing address:
  • Phone: 904-232-2751
  • Fax: 904-232-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPS37097
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: