Individual
JESSICA LIVINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1747 BAPTIST CLAY DR STE 200, FLEMING ISLAND, FL 32003-8505
(904) 290-6446
Mailing address
7950 RAILROAD RD, BRYCEVILLE, FL 32009-1831
(904) 334-0597
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL1807
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL1807
STATE OF FL LICENSE
FL
Enumeration date
01/28/2018
Last updated
01/28/2018
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