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NPI Code Detail

MEDICARE: JESSICA ANN DEMARCO PA-C

MEDICARE: JESSICA ANN DEMARCO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085-004180IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085-004180OTHERILSTATE LICENSE

General Provider Information

NPI Number : 1184908840
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ANN DEMARCO PA-C
Provider Business Mailing Address
First Line : PO BOX 19670
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9670
Country : US
Telephone Number : 217-545-8000
Fax Number : 217-747-1351
Provider Business Practice Location Address
First Line : 109 3RD ST
Second Line :
City : LINCOLN
State : IL
Zip : 62656-2604
Country : US
Telephone Number : 217-735-2317
Fax Number : 217-732-6943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2011
Last Update Date : 04/19/2024

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Directions to “ JESSICA ANN DEMARCO PA-C” Practice Location

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