Provider Demographics
NPI:1477396463
Name:MATTHEWS, JESSCIA (RD)
Entity type:Individual
Prefix:
First Name:JESSCIA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FRONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1100 SEAGATE AVE APT 222
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-3528
Mailing Address - Country:US
Mailing Address - Phone:717-360-4919
Mailing Address - Fax:
Practice Address - Street 1:1100 SEAGATE AVE APT 222
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-3528
Practice Address - Country:US
Practice Address - Phone:717-360-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11755133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered