MEDICARE: MRS. JESSICA LAUREN DELIA M.D.

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	208000000X	Pediatrics Physician	ME110651	FL
2	208D00000X	General Practice Physician	ME110651	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114217163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LAUREN DELIA M.D.

Provider Business Mailing Address
First Line	:	10140 CENTURION PKWY N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0532
Country	:	US
Telephone Number	:	904-697-4127
Fax Number	:	904-697-5102

Provider Business Practice Location Address
First Line	:	1155 35TH LN STE 201A
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6537
Country	:	US
Telephone Number	:	772-562-5661
Fax Number	:	772-562-5702

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	09/20/2019

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