Healthcare Provider Details

I. General information

NPI: 1659855682
Provider Name (Legal Business Name): MRS. JESSICA M.S. CLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 IRONWEDGE DR
ORLANDO FL
32808-3042
US

IV. Provider business mailing address

3815 IRONWEDGE DR
ORLANDO FL
32808-3042
US

V. Phone/Fax

Practice location:
  • Phone: 407-267-2429
  • Fax:
Mailing address:
  • Phone: 407-267-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: