NPI |
1588825053 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Entity Type Code |
1 |
|
Provider Last Name Legal Name |
FINCH |
|
Provider First Name |
JESSICA |
|
Provider Middle Name |
ADELE |
|
Provider Name Prefix Text |
MRS. |
|
Provider Credential Text |
PT |
|
Provider First Line Business Practice Location Address |
2627 RIVERSIDE AVE |
|
Provider Second Line Business Practice Location Address |
SUITE 300 |
|
Provider Business Practice Location Address City Name |
JACKSONVILLE |
|
Provider Business Practice Location Address State Name |
FL |
|
Provider Business Practice Location Address Postal Code |
322044712 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
9046340640 |
|
Provider Business Practice Location Address Fax Number |
9046340203 |
|
Provider Enumeration Date |
6/18/2008 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
9/8/2016 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
225100000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
PT 23182 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 1 |
FL |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
|