MEDICARE: JESSICA LEVAN APRN

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	APRN9326450	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9326450	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1801270129	OTHER		NPI

General Provider Information

NPI Number	:	1801270129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEVAN APRN

Provider Business Mailing Address
First Line	:	23049 PRESERVE CT
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-8758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6641 MADISON ST STE 3
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-1966
Country	:	US
Telephone Number	:	727-203-4417
Fax Number	:

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/01/2025

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