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Individual
JASON LEE KISSICK
Active
Individual
JASON LEE KISSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
9350626
FL
363LF0000X
Family Nurse Practitioner
Primary
11007202
FL
Other
Enumeration date
05/14/2020
Last updated
08/20/2021
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