Healthcare Provider Details

I. General information

NPI: 1437038981
Provider Name (Legal Business Name): JESSENIA GILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13323 PANAMA BEACH CT
ORLANDO FL
32827-3876
US

IV. Provider business mailing address

13323 PANAMA BEACH CT
ORLANDO FL
32827-3876
US

V. Phone/Fax

Practice location:
  • Phone: 856-816-2880
  • Fax:
Mailing address:
  • Phone: 856-816-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11111111111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: