Healthcare Provider Details

I. General information

NPI: 1205628708
Provider Name (Legal Business Name): JESSICA MARIE LIGNELLI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 STRAND ST
FREDERIKSTED VI
00840-3533
US

IV. Provider business mailing address

105 TURPIAL WAY APT 107
MELBOURNE FL
32901-8917
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-0260
  • Fax:
Mailing address:
  • Phone: 407-848-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH18940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: