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NPI Code Detail

MEDICARE: JESSICA RADKE

MEDICARE: JESSICA RADKE
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 : 1720750938
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RADKE
Provider Business Mailing Address
First Line : 3406 W SAN PEDRO ST FL 33629
Second Line :
City : TAMPA
State : FL
Zip : 33629-7923
Country : US
Telephone Number : 904-710-1547
Fax Number : 813-512-2734
Provider Business Practice Location Address
First Line : 3406 W SAN PEDRO ST FL 33629
Second Line :
City : TAMPA
State : FL
Zip : 33629-7923
Country : US
Telephone Number : 904-710-1547
Fax Number : 813-512-2734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2021
Last Update Date : 10/05/2021

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Directions to “ JESSICA RADKE ” Practice Location

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