Provider Demographics
NPI:1821208778
Name:TUNIS, JESSICA ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:TUNIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 DIAMOND COVE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6053
Mailing Address - Country:US
Mailing Address - Phone:908-380-8127
Mailing Address - Fax:
Practice Address - Street 1:4301 SUN N LAKE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2138
Practice Address - Country:US
Practice Address - Phone:863-402-3161
Practice Address - Fax:863-402-8244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2585208600000X
FLOS15443208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810021405Medicaid
WVWV0625B987Medicare PIN