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General NPI Number Information
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NPI Number | 1811300510
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Entity Type | Individual
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Provider Name | JESSICA GREEN
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Gender | Female
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1223 DANIELS RD STE 302
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3835
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Country | US
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Telephone | 689-240-7945
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Fax | 833-973-2664
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Provider Business Mailing Address
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Address Line | 327 ANORAK ST
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City | GROVELAND
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State | FL
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Zip | 34736-9543
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Country | US
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Telephone | 321-266-5014
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Fax | 833-973-2664
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN9303454
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | ARNP9303454
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License Number State | FL
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