Provider Demographics
NPI:1750857694
Name:DEXTER, JESSICA HANNAH (BS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HANNAH
Last Name:DEXTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2541
Mailing Address - Country:US
Mailing Address - Phone:941-773-2223
Mailing Address - Fax:
Practice Address - Street 1:300 S BAY AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2141
Practice Address - Country:US
Practice Address - Phone:407-978-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator