Healthcare Provider Details

I. General information

NPI: 1942655592
Provider Name (Legal Business Name): JESSICA DAWN ANDERSON ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DAWN CLEMENT APRN

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-255-4777
  • Fax: 863-940-4856
Mailing address:
  • Phone: 863-255-4777
  • Fax: 863-940-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9213300
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9213300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: