MEDICARE: JANELLE STEPHANIE DESSOURCES

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	APRN11045338	FL

General Provider Information

NPI Number	:	1457201220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE STEPHANIE DESSOURCES

Provider Business Mailing Address
First Line	:	9330 US 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-6300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 US 301 S
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-6300
Country	:	US
Telephone Number	:	813-471-0000
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/06/2026

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