Healthcare Provider Details

I. General information

NPI: 1285356345
Provider Name (Legal Business Name): JESSELYN MISHELLE VANCE CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSELYN MISHELLE LAMMER

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W HIBISCUS BLVD STE 215
MELBOURNE FL
32901-2627
US

IV. Provider business mailing address

720 COOPER AVE
INVERNESS FL
34450-6508
US

V. Phone/Fax

Practice location:
  • Phone: 321-837-3820
  • Fax:
Mailing address:
  • Phone: 352-201-9258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000223A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: