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NPI Code Detail

MEDICARE: JESSICA E COOK

MEDICARE: JESSICA E COOK
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
1222Q00000XDevelopmental Therapist
2106S00000XBehavior 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 : 1912258955
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA E COOK
Provider Business Mailing Address
First Line : 1409 NW 6TH ST
Second Line : SUITE 120
City : GAINESVILLE
State : FL
Zip : 32601-2234
Country : US
Telephone Number : 352-373-4411
Fax Number :
Provider Business Practice Location Address
First Line : 1408 NW 6TH ST
Second Line :
City : GAINESVILLE
State : FL
Zip : 32601-4020
Country : US
Telephone Number : 352-373-4411
Fax Number : 352-373-4455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2012
Last Update Date : 09/14/2018

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Directions to “ JESSICA E COOK ” Practice Location

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