Provider Demographics
NPI:1184148090
Name:VISNER, JESSICA LAUREN (NP-F)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LAUREN
Last Name:VISNER
Suffix:
Gender:F
Credentials:NP-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 E VENICE AVE # 145
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3197
Mailing Address - Country:US
Mailing Address - Phone:941-468-1157
Mailing Address - Fax:
Practice Address - Street 1:1101 TAMIAMI TRL S STE 108
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4133
Practice Address - Country:US
Practice Address - Phone:941-488-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287613363LF0000X
FL9287613363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health