Healthcare Provider Details

I. General information

NPI: 1235630849
Provider Name (Legal Business Name): JESSICA A. WILLISON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A. SPALDING

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 TAYLOR AVE STE A19
ORLANDO FL
32806-4474
US

IV. Provider business mailing address

2830 PLAZA TERRACE DR
ORLANDO FL
32803-2816
US

V. Phone/Fax

Practice location:
  • Phone: 407-717-4704
  • Fax:
Mailing address:
  • Phone: 407-717-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: