Provider Demographics
NPI:1538319439
Name:CROSBY, JESSICA M (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SW IMPORT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2408
Mailing Address - Country:US
Mailing Address - Phone:772-215-5278
Mailing Address - Fax:772-878-5455
Practice Address - Street 1:690 SE MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4410
Practice Address - Country:US
Practice Address - Phone:772-215-5278
Practice Address - Fax:772-878-5455
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA:24155171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor