Healthcare Provider Details

I. General information

NPI: 1619485182
Provider Name (Legal Business Name): JESSICA WHELAN CRNA, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
POMPANO BEACH FL
33064-3502
US

IV. Provider business mailing address

22291 KETTLE CREEK WAY
BOCA RATON FL
33428-4738
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-8300
  • Fax:
Mailing address:
  • Phone: 561-251-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9345450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: