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General NPI Number Information
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NPI Number | 1346818937
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Entity Type | Individual
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Provider Name | JESSICA ANNE DALE AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 340 HEALD WAY STE 238
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City | THE VILLAGES
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State | FL
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Zip | 32163-6088
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Country | US
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Telephone | 866-400-3376
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Fax | 863-709-0273
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Provider Business Mailing Address
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Address Line | 151 SOUTHHALL LN STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7172
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Country | US
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Telephone | 866-400-3376
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Fax | 407-650-3455
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11011211
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License Number State | FL
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