Healthcare Provider Details

I. General information

NPI: 1083375638
Provider Name (Legal Business Name): JESSICA JOYCE LAKEY LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 COLLEGE DR
MIDDLEBURG FL
32068-8526
US

IV. Provider business mailing address

PO BOX 207
PENNEY FARMS FL
32079-0207
US

V. Phone/Fax

Practice location:
  • Phone: 904-290-4114
  • Fax:
Mailing address:
  • Phone: 904-290-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: