MEDICARE: MS. JERRAH MARIA MOSTKOFF 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
1	363A00000X	Physician Assistant	PA9114907	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	O0REO	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528553682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JERRAH MARIA MOSTKOFF PA-C

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 TAMPA GENERAL CIR
Second Line	:	HMT SUITE 820
City	:	TAMPA
State	:	FL
Zip	:	33606-3658
Country	:	US
Telephone Number	:	813-844-3228
Fax Number	:	813-844-7730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/27/2024

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