Provider Demographics
NPI:1598428880
Name:NIEVES, JESSICA MARIA (BC-HIS, HAS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:BC-HIS, HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E SAN SEBASTIAN CT
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3018
Mailing Address - Country:US
Mailing Address - Phone:407-791-2594
Mailing Address - Fax:
Practice Address - Street 1:478 E ALTAMONTE DR STE 110
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4615
Practice Address - Country:US
Practice Address - Phone:407-767-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5350237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist