Provider Demographics
NPI:1306534961
Name:KOFMAN, JESSICA (FNP-BC, PMHNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KOFMAN
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 MULBERRY GARDEN TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-5091
Mailing Address - Country:US
Mailing Address - Phone:480-207-8627
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9476
Practice Address - Country:US
Practice Address - Phone:561-814-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028063363LP0808X, 363LF0000X
AZ251122363LF0000X
FL11028063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty