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NPI Code Detail

MEDICARE: JESSICA QUAM

MEDICARE: JESSICA QUAM
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
1106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1316342264
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA QUAM
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 407-915-7729
Fax Number :
Provider Business Practice Location Address
First Line : 17815 HUNTING BOW CIR
Second Line :
City : LUTZ
State : FL
Zip : 33558-5401
Country : US
Telephone Number : 813-491-4425
Fax Number : 813-482-9790
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 10/28/2019

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Directions to “ JESSICA QUAM ” Practice Location

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