Healthcare Provider Details

I. General information

NPI: 1568048445
Provider Name (Legal Business Name): JESSIKA HELENA WIDERMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 PROSPERITY FARMS RD STE E-121
PALM BEACH GARDENS FL
33410-3474
US

IV. Provider business mailing address

11380 PROSPERITY FARMS RD STE E-121
PALM BEACH GARDENS FL
33410-3474
US

V. Phone/Fax

Practice location:
  • Phone: 561-559-1110
  • Fax: 561-559-1118
Mailing address:
  • Phone: 561-559-1110
  • Fax: 561-559-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347118
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN9337421
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: