MEDICARE: JESSICA BUCKMIRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND8962	FL

General Provider Information

NPI Number	:	1063201283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BUCKMIRE

Provider Business Mailing Address
First Line	:	19191 NW 23RD PL
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-5346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10040 SHERIDAN ST APT 310
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-8542
Country	:	US
Telephone Number	:	954-397-0338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2025
Last Update Date	:	01/12/2026

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