Active NPI
Jessica Ezelle
- Radiological Physics Physician
- Mount Dora, FL
National Provider Identifier
1225973274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiological Physics Physician
- License
- CRT80851
- Practice address
- 4607 Coppola Dr
Mount Dora, FL 32757-8068 - Phone
- (912) 665-3714
- NPI assigned
- Apr 23, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiological Physics Physician | 2085R0205X | CRT80851 | FL | Primary |
Addresses
Primary practice location
4607 Coppola Dr
Mount Dora, FL 32757-8068
Mailing address
4607 Coppola Dr
Mount Dora, FL 32757-8068
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CRT80851 | FL | MD | Radiological Physics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1776902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776902400000",
"number": "1225973274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4607 COPPOLA DR",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327578068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4607 COPPOLA DR",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327578068",
"telephone_number": "912-665-3714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZELLE",
"first_name": "JESSICA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-04-23",
"last_updated": "2026-04-23",
"certification_date": "2026-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0205X",
"taxonomy_group": "",
"desc": "Radiology, Radiological Physics",
"state": "FL",
"license": "CRT80851",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Dora, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.