Provider Demographics
NPI:1912539982
Name:PRICE, JESSICA CAROLYN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROLYN
Last Name:PRICE
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 1:1387 FRUIT COVE FOREST RD N
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2810
Mailing Address - Country:US
Mailing Address - Phone:904-571-2300
Mailing Address - Fax:
Practice Address - Street 1:1387 FRUIT COVE FOREST RD N
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2810
Practice Address - Country:US
Practice Address - Phone:904-571-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer