Provider Demographics
NPI:1275975237
Name:MACE, JESSE LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:MACE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 AMALFI CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-4400
Mailing Address - Country:US
Mailing Address - Phone:772-226-0425
Mailing Address - Fax:949-437-8585
Practice Address - Street 1:3735 11TH CIR STE 103
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4884
Practice Address - Country:US
Practice Address - Phone:772-770-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9432066363LF0000X
FL9432066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily