Provider Demographics
NPI:1346471042
Name:WHITE VIDEA, JESSICA (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WHITE VIDEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2855 N UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1404
Mailing Address - Country:US
Mailing Address - Phone:954-317-0772
Mailing Address - Fax:954-317-0778
Practice Address - Street 1:2855 N UNIVERSITY DR STE 300
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1404
Practice Address - Country:US
Practice Address - Phone:954-317-0772
Practice Address - Fax:954-317-0778
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology