Individual
JESSICA COLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4643 TODD ST, LAKE WORTH, FL 33463-3442
(561) 215-3974
Mailing address
4643 TODD ST, LAKE WORTH, FL 33463-3442
(561) 215-3974
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
C450-420-86-8701
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C450-420-86-8701
DRIVERS LICENSE
FL
01
—
C450-420-86-8701
DRIVER'S LICENSE
—
Enumeration date
05/13/2022
Last updated
05/13/2022
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