Provider Demographics
NPI:1104546019
Name:TADDEO, JESSICA LEE (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:TADDEO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 STONINGTON RUN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2124
Mailing Address - Country:US
Mailing Address - Phone:508-887-5083
Mailing Address - Fax:
Practice Address - Street 1:2546 SIMPSON ROAD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744
Practice Address - Country:US
Practice Address - Phone:407-632-4217
Practice Address - Fax:407-632-4226
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022045349363LF0000X
FLAPRN11022230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily