Healthcare Provider Details

I. General information

NPI: 1417003559
Provider Name (Legal Business Name): MRS. JESSICA LEIGH WAGNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LEIGH SCHAER

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 7TH AVE N
ST PETERSBURG FL
33701-2316
US

IV. Provider business mailing address

4300 78TH ST N
ST PETERSBURG FL
33709-4426
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-6843
  • Fax: 727-767-4715
Mailing address:
  • Phone: 727-560-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: