MEDICARE: MISS JESSICA PAULA

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	225700000X	Massage Therapist	92216	FL

General Provider Information

NPI Number	:	1568319812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA PAULA

Provider Business Mailing Address
First Line	:	6711 VACARO ST # 55
Second Line	:
City	:	LABELLE
State	:	FL
Zip	:	33935-5522
Country	:	US
Telephone Number	:	305-609-0545
Fax Number	:

Provider Business Practice Location Address
First Line	:	5285 SUMMERLIN RD STE 101A
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7601
Country	:	US
Telephone Number	:	305-609-1476
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ MISS JESSICA PAULA ” Practice Location

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