Healthcare Provider Details

I. General information

NPI: 1215432059
Provider Name (Legal Business Name): MISS JESSENIA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5922 CATTLEMEN LN STE 100
SARASOTA FL
34232-6204
US

IV. Provider business mailing address

5922 CATTLEMEN LN STE 100
SARASOTA FL
34232-6204
US

V. Phone/Fax

Practice location:
  • Phone: 941-378-8977
  • Fax:
Mailing address:
  • Phone: 941-378-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: