Provider Demographics
NPI:1790098788
Name:OKUN, JESSICA FAY (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:FAY
Last Name:OKUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3540 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6637
Mailing Address - Country:US
Mailing Address - Phone:954-653-3722
Mailing Address - Fax:954-653-3728
Practice Address - Street 1:3540 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6637
Practice Address - Country:US
Practice Address - Phone:954-653-3722
Practice Address - Fax:954-653-3728
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13918207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018280700Medicaid