Healthcare Provider Details

I. General information

NPI: 1851267397
Provider Name (Legal Business Name): JESSICA POURANFAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N MERIDIAN RD
TALLAHASSEE FL
32303-5646
US

IV. Provider business mailing address

1700 N MERIDIAN RD
TALLAHASSEE FL
32303-5646
US

V. Phone/Fax

Practice location:
  • Phone: 229-400-0722
  • Fax:
Mailing address:
  • Phone: 229-400-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA POURANFAR
Title or Position: MUSIC THERAPIST
Credential: MT-BC
Phone: 502-269-7467