=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851082796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA CAMPESTRINI PA-C, MPAS, MSC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2023
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1131 S ORANGE AVE
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-444-0011
-----------------------------------------------------
Fax | 603-952-3900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3572 CHINKAPIN OAK LN
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-654-1288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9117734
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------