Individual
JESSICA AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
603 N FLAMINGO ROAD, STE 157, PEMBROKE PINES, FL 33028
(954) 265-4325
(954) 438-5191
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP 9250148
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017950300
—
FL
Enumeration date
05/17/2012
Last updated
03/19/2021
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