Healthcare Provider Details

I. General information

NPI: 1134684665
Provider Name (Legal Business Name): JESSICA D KOEHLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13330 USF LAUREL DR
TAMPA FL
33612-6601
US

IV. Provider business mailing address

13330 USF LAUREL DR
TAMPA FL
33612-6601
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8033
  • Fax: 813-821-8339
Mailing address:
  • Phone: 813-821-8033
  • Fax: 813-821-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: