Healthcare Provider Details

I. General information

NPI: 1487072609
Provider Name (Legal Business Name): JESSICA MONIQUE COVINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 PRIMERA BLVD STE 1031
LAKE MARY FL
32746-2124
US

IV. Provider business mailing address

785 PRIMERA BLVD STE 1031
LAKE MARY FL
32746-2124
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-8111
  • Fax: 407-834-8506
Mailing address:
  • Phone: 407-834-8111
  • Fax: 407-834-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME136288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: