Healthcare Provider Details

I. General information

NPI: 1407044258
Provider Name (Legal Business Name): JESSICA E. B. WASSERMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

IV. Provider business mailing address

5955 RAND BLVD
SARASOTA FL
34238-5160
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-7508
  • Fax: 941-552-7605
Mailing address:
  • Phone: 941-552-7508
  • Fax: 941-552-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS-9057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: