MEDICARE: JESSICA GREEN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN9303454	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9303454	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811300510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GREEN

Provider Business Mailing Address
First Line	:	327 ANORAK ST
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-9543
Country	:	US
Telephone Number	:	321-266-5014
Fax Number	:	833-973-2664

Provider Business Practice Location Address
First Line	:	1223 DANIELS RD STE 302
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3835
Country	:	US
Telephone Number	:	689-240-7945
Fax Number	:	833-973-2664

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

Provider Enumeration Date	:	06/10/2014
Last Update Date	:	07/01/2025

Similar Medicare Providers

1619357787 — KRISTOPHER OLDHAM PMHNP-BC
Practice Location Address:

1223 DANIELS RD
WINTER GARDEN, FL
34787-3835

Practice Phone: 689-240-7945
Practice Fax:

1396479697 — TOTALLY PSYCHED, LLC
Practice Location Address:

1223 DANIELS RD
WINTER GARDEN, FL
34787-3835

Practice Phone: 689-240-7945
Practice Fax: 833-973-2664

1538029301 — BALANCED WELLNESS THERAPEUTIC SERVICES, INC.
Practice Location Address:

1223 DANIELS RD
WINTER GARDEN, FL
34787-3835

Practice Phone: 407-797-1435
Practice Fax:

1235948134 — BEVERLY RESIDENTIAL CARE LLC
Practice Location Address:

9771 BEVERLY LN
GARDEN GROVE, CA
92841-3835

Practice Phone: 714-300-4540
Practice Fax:

1295419844 — DR. JACOB RYAN MARTY DO
Practice Location Address:

2000 FOWLER GROVE BLVD
WINTER GARDEN, FL
34787-5050

Practice Phone: 407-614-0500
Practice Fax:

1225736119 — MEGAN CREAMER
Practice Location Address:

32 E MILLER ST
WINTER GARDEN, FL
34787-3570

Practice Phone: 407-683-1072
Practice Fax:

Directions to “ JESSICA GREEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.