Provider Demographics
NPI:1518508555
Name:CALLAHAN, JESSE JAMES (RN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:JAMES
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 CURTISS AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8128
Mailing Address - Country:US
Mailing Address - Phone:774-205-4937
Mailing Address - Fax:
Practice Address - Street 1:JERRI-JEAN MILLER
Practice Address - Street 2:CLINICAL STAFF AFFAIRS VA HEALTHCARE SYSTEM
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1252
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2025-07-22
Deactivation Date:2019-11-06
Deactivation Code:
Reactivation Date:2025-07-22
Provider Licenses
StateLicense IDTaxonomies
FLRN9510099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse