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General NPI Number Information
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NPI Number | 1790672814
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Entity Type | Individual
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Provider Name | JESSICA CHEREVKO R. EP T., CNIM
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Gender | Female
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 350 CORREYDALE CT
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City | JACKSONVILLE
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State | FL
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Zip | 32225-3302
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number | 1809
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License Number State |
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