Active NPI
Alecia Vanessa Stephanie Jack
- Homemaker
- Kissimmee, FL
National Provider Identifier
1972067262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- License
- BTR13349
- Practice address
- 1909 Brack St
Kissimmee, FL 34744-3422 - Phone
- (772) 713-1397
- NPI assigned
- Jan 30, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Homemaker | 376J00000X | BTR13349 | FL | Primary |
Addresses
Primary practice location
1909 Brack St
Kissimmee, FL 34744-3422
Mailing address
1909 Brack St
Kissimmee, FL 34744-3422
Phone (772) 713-1397
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 |
|---|---|---|---|
| BTR13349 | FL | MD | Homemaker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548806400000",
"number": "1972067262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1909 BRACK ST",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347443422",
"telephone_number": "772-713-1397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1909 BRACK ST",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347443422",
"telephone_number": "772-713-1397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "ALECIA",
"middle_name": "VANESSA STEPHANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-30",
"last_updated": "2019-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": "FL",
"license": "BTR13349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.