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General NPI Number Information
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NPI Number | 1487396925
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Entity Type | Individual
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Provider Name | JESSICA CANOSA
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Gender | Female
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | FLORIDA ATLANTIC UNIVERSITY NEUROLOGY RESIDENCY PROGRAM 800 MEADOWS ROAD
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City | BOCA RATON
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State | FL
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Zip | 33486
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Country | US
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Telephone | 561-955-3945
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Fax | 866-622-2185
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Provider Business Mailing Address
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Address Line | 580 W 8TH ST FL 19
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6533
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Country | US
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Telephone | 904-383-1022
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Fax | 904-244-9789
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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