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General NPI Number Information
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NPI Number | 1063201283
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Entity Type | Individual
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Provider Name | JESSICA BUCKMIRE
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Gender | Female
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 10040 SHERIDAN ST APT 310
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-8542
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Country | US
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Telephone | 954-397-0338
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Fax |
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Provider Business Mailing Address
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Address Line | 19191 NW 23RD PL
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5346
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND8962
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License Number State | FL
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