Provider Demographics
NPI:1891471595
Name:WINDOM, JESSIE LEE JR
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:LEE
Last Name:WINDOM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 CAVENDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-7675
Mailing Address - Country:US
Mailing Address - Phone:352-933-5711
Mailing Address - Fax:
Practice Address - Street 1:1181 CAVENDER CREEK RD
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-7675
Practice Address - Country:US
Practice Address - Phone:352-933-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)