Basic Information
| Provider Information | |||||||||
| NPI: | 1033164231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAUGHT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 3218412442 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328061133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 3218412442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 11/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD035459 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101237916 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | D0062938 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | ME97643 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | ME97643 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 277453400 | 05 | FL | MEDICAID | ME97643 | 01 | FL | MEDICAL LICENSE | OTHER |