Healthcare Provider Details

I. General information

NPI: 1639016538
Provider Name (Legal Business Name): JESSICA SOPHIA JANNECK-KOWALEWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JESSICA SOPHIA JANNECK

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 US HIGHWAY 98 W
MIRAMAR BEACH FL
32550-7228
US

IV. Provider business mailing address

8827 GRISTMILL WAY
MILTON FL
32583-7550
US

V. Phone/Fax

Practice location:
  • Phone: 850-737-8750
  • Fax:
Mailing address:
  • Phone: 201-988-0371
  • Fax: 201-988-0371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: