Healthcare Provider Details

I. General information

NPI: 1750202321
Provider Name (Legal Business Name): MRS. JESSICA L TRUITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GRAND BLVD STE 206
MIRAMAR BEACH FL
32550-1897
US

IV. Provider business mailing address

495 GRAND BLVD STE 206
MIRAMAR BEACH FL
32550-1897
US

V. Phone/Fax

Practice location:
  • Phone: 305-589-6660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2832246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: