Provider Demographics
NPI:1407122468
Name:CUPIDO, JESSICA G (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:G
Last Name:CUPIDO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-284-2212
Mailing Address - Fax:
Practice Address - Street 1:2020 TOWN CENTER BLVD STE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2906
Practice Address - Country:US
Practice Address - Phone:813-284-2212
Practice Address - Fax:813-377-1713
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS138898208100000X
FLOS138982081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023320500Medicaid