Provider Demographics
NPI:1881489680
Name:JESNASUBLETT, PLLC
Entity type:Organization
Organization Name:JESNASUBLETT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESNA
Authorized Official - Middle Name:SUSAN MATHEW
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:386-222-2792
Mailing Address - Street 1:1431 ORANGE CAMP RD STE 115
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7770
Mailing Address - Country:US
Mailing Address - Phone:386-222-2792
Mailing Address - Fax:386-478-4905
Practice Address - Street 1:1431 ORANGE CAMP RD STE 115
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7770
Practice Address - Country:US
Practice Address - Phone:386-222-2792
Practice Address - Fax:386-478-4905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty