Provider Demographics
NPI:1821608944
Name:ALIPOUR, JESSICA M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:ALIPOUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21001 NE 24TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1021
Mailing Address - Country:US
Mailing Address - Phone:305-987-4112
Mailing Address - Fax:
Practice Address - Street 1:21001 NE 24TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1021
Practice Address - Country:US
Practice Address - Phone:305-987-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily