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General NPI Number Information
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NPI Number | 1568048445
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Entity Type | Individual
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Provider Name | JESSIKA HELENA WIDERMAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 11380 PROSPERITY FARMS RD STE E-121
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3474
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Country | US
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Telephone | 561-559-1110
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Fax | 561-559-1118
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Provider Business Mailing Address
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Address Line | 11380 PROSPERITY FARMS RD STE E-121
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3474
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Country | US
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Telephone | 561-559-1110
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Fax | 561-559-1118
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 347118
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | RN9337421
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11012513
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License Number State | FL
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