Provider Demographics
NPI:1659098408
Name:O'NEILL, JESSICA (AP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 SE GOMEZ AVE
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-3243
Mailing Address - Country:US
Mailing Address - Phone:561-714-8442
Mailing Address - Fax:
Practice Address - Street 1:8908 SE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-5311
Practice Address - Country:US
Practice Address - Phone:561-202-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
FL4322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist