Healthcare Provider Details

I. General information

NPI: 1427673011
Provider Name (Legal Business Name): JESSICA MILNOR LAMOS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3278
US

IV. Provider business mailing address

1220 TWO OAKS BLVD
MERRITT ISLAND FL
32952-6051
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7000
  • Fax:
Mailing address:
  • Phone: 321-987-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: