Provider Demographics
NPI:1093140592
Name:EL-BAHRI, JESSICA FONSECA (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FONSECA
Last Name:EL-BAHRI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18167 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 650
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-3528
Mailing Address - Country:US
Mailing Address - Phone:727-437-0859
Mailing Address - Fax:
Practice Address - Street 1:18167 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 650
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3528
Practice Address - Country:US
Practice Address - Phone:727-437-0859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine