Healthcare Provider Details

I. General information

NPI: 1215639943
Provider Name (Legal Business Name): JESSICA DIANE VELOZA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S MONROE ST
TALLAHASSEE FL
32301-6303
US

IV. Provider business mailing address

3273 LORD MURPHY TRL
TALLAHASSEE FL
32309-1757
US

V. Phone/Fax

Practice location:
  • Phone: 850-354-8765
  • Fax: 850-900-5941
Mailing address:
  • Phone: 850-510-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11025238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: