MEDICARE: JA'LISSA M PRESVOT BA

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	171M00000X	Case Manager/Care Coordinator		FL

General Provider Information

NPI Number	:	1750272175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JA'LISSA M PRESVOT BA

Provider Business Mailing Address
First Line	:	2215 E HENRY AVE STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4460
Country	:	US
Telephone Number	:	813-272-2244
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 E HENRY AVE STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-4460
Country	:	US
Telephone Number	:	813-272-2244
Fax Number	:

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

Provider Enumeration Date	:	07/14/2025
Last Update Date	:	07/21/2025

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