Provider Demographics
NPI:1053457739
Name:STEVENSON, JESSICA LEIGH (LM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:STEVENSON
Suffix:
Gender:
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5261
Mailing Address - Country:US
Mailing Address - Phone:352-278-1007
Mailing Address - Fax:386-462-9021
Practice Address - Street 1:PO BOX 100294
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-2944
Practice Address - Country:US
Practice Address - Phone:352-278-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW171176B00000X
FLAPRN11038195367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014378000Medicaid