Provider Demographics
NPI:1417551995
Name:DICKSON, JESSICA LEA (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:DICKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:VOUTOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:540 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2900
Mailing Address - Country:US
Mailing Address - Phone:941-486-6927
Mailing Address - Fax:
Practice Address - Street 1:2202 ALPINE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4114
Practice Address - Country:US
Practice Address - Phone:941-685-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010319363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner