Provider Demographics
NPI:1346818937
Name:DALE, JESSICA ANNE (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:DALE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HEALD WAY STE 238
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-6088
Mailing Address - Country:US
Mailing Address - Phone:407-808-4741
Mailing Address - Fax:
Practice Address - Street 1:340 HEALD WAY STE 238
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6088
Practice Address - Country:US
Practice Address - Phone:352-565-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011211208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice