Healthcare Provider Details

I. General information

NPI: 1932014107
Provider Name (Legal Business Name): JESSICA MAE WEAVER MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 RICKENBACKER DR
SUN CITY CENTER FL
33573-5332
US

IV. Provider business mailing address

12126 BARNSLEY RESERVE PL
GIBSONTON FL
33534-5675
US

V. Phone/Fax

Practice location:
  • Phone: 813-999-1516
  • Fax:
Mailing address:
  • Phone: 813-315-0658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11049869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: