Individual
JESSICA DEKLAVON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1150 N 35TH AVE STE 130, HOLLYWOOD, FL 33021-5424
(954) 265-7700
(954) 276-0021
Mailing address
1150 N 35TH AVE STE 130, HOLLYWOOD, FL 33021-5424
(954) 265-7700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9115460
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9115460
DEPARTMENT OF HEALTH
FL
Enumeration date
03/22/2022
Last updated
04/27/2026
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