Healthcare Provider Details

I. General information

NPI: 1033647367
Provider Name (Legal Business Name): MISS JESSICA N NJOPSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MOSS PARK RD
ORLANDO FL
32832-6086
US

IV. Provider business mailing address

10409 LAXTON ST
ORLANDO FL
32824-4433
US

V. Phone/Fax

Practice location:
  • Phone: 407-930-4339
  • Fax:
Mailing address:
  • Phone: 407-729-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: