Jackie Jessurun, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5155284 Issued in FL

Practice address

111 NW 183Rd St
Suite 500
Miami Gardens, FL 33169-4537

Phone

(305) 892-4753

Fax

(305) 493-0814

NPI assigned

Nov 1, 2007

Last updated

Nov 1, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193875200000",
    "number": "1427237973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NW 183RD ST",
            "address_2": "SUITE 500",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331694537",
            "telephone_number": "305-892-4753",
            "fax_number": "305-493-0814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NW 183RD ST",
            "address_2": "SUITE 500",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331694537",
            "telephone_number": "305-892-4753",
            "fax_number": "305-493-0814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESSURUN",
        "first_name": "JACKIE",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-01",
        "last_updated": "2007-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5155284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Miami Gardens, FL
• Providers in Miami Gardens, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.