Healthcare Provider Details

I. General information

NPI: 1629933247
Provider Name (Legal Business Name): JESSIKA NEGRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 NW 5TH ST STE 200
PLANTATION FL
33317-1613
US

IV. Provider business mailing address

733 LAKE BLVD
WESTON FL
33326-3535
US

V. Phone/Fax

Practice location:
  • Phone: 954-612-9175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: