Provider Demographics
NPI:1831588201
Name:LEE, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEE
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 1:500 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:VAN HORN
Mailing Address - State:TX
Mailing Address - Zip Code:79855-2298
Mailing Address - Country:US
Mailing Address - Phone:432-283-3160
Mailing Address - Fax:
Practice Address - Street 1:4901 MARKET PLACE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-484-4080
Practice Address - Fax:850-484-8801
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-175236363LF0000X
FL9398727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily