Provider Demographics
NPI:1346803160
Name:WHISENANT, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:WHISENANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 AMNESTY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34288-6817
Mailing Address - Country:US
Mailing Address - Phone:941-312-1181
Mailing Address - Fax:
Practice Address - Street 1:1901 AMNESTY DR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-6817
Practice Address - Country:US
Practice Address - Phone:941-312-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker