Healthcare Provider Details

I. General information

NPI: 1093428385
Provider Name (Legal Business Name): JESSICA K DEDGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 M D LN STE A
TALLAHASSEE FL
32308-5349
US

IV. Provider business mailing address

PO BOX 1133
MADISON FL
32341-5133
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-0635
  • Fax: 850-205-0195
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11025654
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9374751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: