MEDICARE: JESSICA LAUREN LEE APRN

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	363LF0000X	Family Nurse Practitioner	RN242807	GA
2	363LF0000X	Family Nurse Practitioner	APRN11007645	FL

General Provider Information

NPI Number	:	1255983466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LAUREN LEE APRN

Provider Business Mailing Address
First Line	:	2255 KILLEARN CENTER BLVD STE 100
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 KILLEARN CENTER BLVD STE 100
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3562
Country	:	US
Telephone Number	:	850-877-1162
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	03/27/2023

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