Provider Demographics
NPI:1083459481
Name:JEANTY, JESSICA ASTRIDE
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ASTRIDE
Last Name:JEANTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4821
Mailing Address - Country:US
Mailing Address - Phone:954-371-0838
Mailing Address - Fax:954-481-0334
Practice Address - Street 1:2719 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4821
Practice Address - Country:US
Practice Address - Phone:954-371-0838
Practice Address - Fax:954-481-0334
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)