Healthcare Provider Details

I. General information

NPI: 1306534961
Provider Name (Legal Business Name): JESSICA KOFMAN FNP-BC, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 S CONGRESS AVE
WEST PALM BEACH FL
33406-5172
US

IV. Provider business mailing address

11010 MULBERRY GARDEN TRL
BOYNTON BEACH FL
33473-5091
US

V. Phone/Fax

Practice location:
  • Phone: 561-814-8143
  • Fax: 855-526-7606
Mailing address:
  • Phone: 480-207-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11028063
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: