Healthcare Provider Details

I. General information

NPI: 1063372258
Provider Name (Legal Business Name): VISSER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1892 SW GATLIN BLVD
PORT SAINT LUCIE FL
34953
US

IV. Provider business mailing address

1892 SW GATLIN BLVD
PORT SAINT LUCIE FL
34953
US

V. Phone/Fax

Practice location:
  • Phone: 772-475-5369
  • Fax: 772-213-0304
Mailing address:
  • Phone: 772-475-5369
  • Fax: 772-213-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA VISSER
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 772-475-5369