Healthcare Provider Details

I. General information

NPI: 1174849087
Provider Name (Legal Business Name): JESSI N SUMINSKI BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6014 SAN JOSE BLVD W
JACKSONVILLE FL
32217-2365
US

IV. Provider business mailing address

6014 SAN JOSE BLVD W 6014 SAN JOSE BLVD
JACKSONVILLE FL
32217-2365
US

V. Phone/Fax

Practice location:
  • Phone: 904-425-4393
  • Fax: 904-425-4394
Mailing address:
  • Phone: 904-425-4393
  • Fax: 904-425-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: