Provider Demographics
NPI:1679464358
Name:REGISTER, JESSICA AUDREY
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:AUDREY
Last Name:REGISTER
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 1:1893 BANNING BEACH RD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2056
Mailing Address - Country:US
Mailing Address - Phone:352-455-7676
Mailing Address - Fax:
Practice Address - Street 1:235 E PRINCETON ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5555
Practice Address - Country:US
Practice Address - Phone:407-303-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9435893163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk