Healthcare Provider Details

I. General information

NPI: 1861416844
Provider Name (Legal Business Name): JESSICA BROOKE FERANEC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA BROOKE HILLARD M.D.

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 VETERANS WAY OFC 3N122
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

13800 VETERANS WAY OFC 3N122
ORLANDO FL
32827-7401
US

V. Phone/Fax

Practice location:
  • Phone: 407-631-3777
  • Fax:
Mailing address:
  • Phone: 407-631-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME87588
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME87588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: