Provider Demographics
NPI:1740892413
Name:JANUSZEWSKI, JESSICA (NP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JANUSZEWSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHEPERUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1601 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4484
Mailing Address - Country:US
Mailing Address - Phone:321-327-7797
Mailing Address - Fax:321-327-7789
Practice Address - Street 1:1601 S APOLLO BLVD STE C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4484
Practice Address - Country:US
Practice Address - Phone:516-592-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9407222163W00000X
FL11011617363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse