Provider Demographics
NPI:1558965194
Name:MAGNALDI, JESSICA S (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:S
Last Name:MAGNALDI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3204
Mailing Address - Country:US
Mailing Address - Phone:321-312-3501
Mailing Address - Fax:
Practice Address - Street 1:140 6TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3204
Practice Address - Country:US
Practice Address - Phone:321-312-3501
Practice Address - Fax:321-723-9176
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011428363LA2200X, 363LA2200X
CT121224163W00000X
CT9224363L00000X
NYF310088-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner