Healthcare Provider Details

I. General information

NPI: 1093675639
Provider Name (Legal Business Name): JESSICA EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PINNACLES DR STE 700
PALM COAST FL
32164-2915
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 350
JACKSONVILLE FL
32256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 386-387-8500
  • Fax: 386-387-8511
Mailing address:
  • Phone: 904-363-7453
  • Fax: 904-538-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number253073
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11048965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: