Provider Demographics
NPI:1760813240
Name:ELGIN, JESSICA
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:ELGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7936 MERCHANTVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-2073
Mailing Address - Country:US
Mailing Address - Phone:386-249-0103
Mailing Address - Fax:
Practice Address - Street 1:3491 GANDY BLVD N
Practice Address - Street 2:SUITE 201
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2658
Practice Address - Country:US
Practice Address - Phone:386-249-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker