Healthcare Provider Details

I. General information

NPI: 1023495801
Provider Name (Legal Business Name): JESSICA BURKETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 LAKE LUCIEN DR STE 112
MAITLAND FL
32751-7233
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S STE 255
JACKSONVILLE FL
32216-4230
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-9029
  • Fax: 844-410-7960
Mailing address:
  • Phone: 904-396-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15750-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27349
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030777
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114760
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA160390
License Number StateIA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9303822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: