Healthcare Provider Details

I. General information

NPI: 1164167359
Provider Name (Legal Business Name): JESSICA PAIGE AMMON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 SLIGH BLVD
ORLANDO FL
32806-3901
US

IV. Provider business mailing address

1335 SLIGH BLVD
ORLANDO FL
32806-3901
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5724
  • Fax:
Mailing address:
  • Phone: 321-841-5724
  • Fax: 321-841-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: