Healthcare Provider Details

I. General information

NPI: 1154237287
Provider Name (Legal Business Name): JESSICA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 N SOCRUM LOOP RD
LAKELAND FL
33809-4182
US

IV. Provider business mailing address

4627 COPPER LN
PLANT CITY FL
33566-1233
US

V. Phone/Fax

Practice location:
  • Phone: 863-853-3000
  • Fax:
Mailing address:
  • Phone: 813-495-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA67745
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: