Healthcare Provider Details

I. General information

NPI: 1922450824
Provider Name (Legal Business Name): JASMINE MAREE HESS-CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 10/20/2023
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S LAKE DESTINY RD STE 350
MAITLAND FL
32751-7222
US

IV. Provider business mailing address

905 LAKE LILY DR APT C301
MAITLAND FL
32751-7670
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-6555
  • Fax:
Mailing address:
  • Phone: 484-201-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11939875
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: