Individual
JESSICA EZELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4607 COPPOLA DR, MOUNT DORA, FL 32757-8068
(912) 665-3714
Mailing address
4607 COPPOLA DR, MOUNT DORA, FL 32757-8068
Taxonomy
Speciality
Code
Description
License number
State
2085R0205X
Radiological Physics Physician
Primary
CRT80851
FL
Other
Enumeration date
04/23/2026
Last updated
04/23/2026
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