Provider Demographics
NPI:1215209796
Name:JARVIS, JESSICA ELLEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELLEN
Last Name:JARVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4847
Mailing Address - Country:US
Mailing Address - Phone:352-341-1212
Mailing Address - Fax:
Practice Address - Street 1:102 E HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4847
Practice Address - Country:US
Practice Address - Phone:352-341-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44900183500000X
VA0202209859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist