Individual
JESSICA DAWN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-C
Contact information
Practice address
4315 HIGHLAND PARK BLVD, LAKELAND, FL 33813-1639
(863) 255-4777
(863) 940-4856
Mailing address
4315 HIGHLAND PARK BLVD, LAKELAND, FL 33813-1639
(863) 255-4777
(863) 940-4856
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN9213300
FL
363LG0600X
Gerontology Nurse Practitioner
ARNP9213300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017604000
—
FL
01
—
IU868Z
MEDICAID
FL
Enumeration date
05/02/2016
Last updated
03/09/2022
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