Provider Demographics
NPI:1215299862
Name:MCCAIN, JESSICA COLLINS (MD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:COLLINS
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4228
Mailing Address - Country:US
Mailing Address - Phone:772-252-0140
Mailing Address - Fax:772-577-7527
Practice Address - Street 1:305 S 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4228
Practice Address - Country:US
Practice Address - Phone:772-252-0140
Practice Address - Fax:772-577-7527
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 121229207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine