Provider Demographics
NPI:1427556141
Name:LIVINGSTON, JESSICA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 RAILROAD RD
Mailing Address - Street 2:
Mailing Address - City:BRYCEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32009-1831
Mailing Address - Country:US
Mailing Address - Phone:904-334-0597
Mailing Address - Fax:
Practice Address - Street 1:1747 BAPTIST CLAY DR STE 200
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8505
Practice Address - Country:US
Practice Address - Phone:904-290-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL18072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL1807OtherSTATE OF FL LICENSE