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1538134721

NPI Code Detail

MEDICARE: MR. JARROD D ROUSSEL PA.-C

MEDICARE: MR. JARROD D ROUSSEL 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	PA9110302	FL
2	363A00000X	Physician Assistant	0110-010484	VA
3	363A00000X	Physician Assistant	085.010957	IL
4	363A00000X	Physician Assistant	10629	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3720420	OTHER	TN	MEDICARE
2	KN153	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1538134721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JARROD D ROUSSEL PA.-C

Provider Business Mailing Address
First Line	:	487 MEADOW LAKE DR
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-2356
Country	:	US
Telephone Number	:	850-400-4245
Fax Number	:

Provider Business Practice Location Address
First Line	:	9700 N 91ST ST STE A115
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-5036
Country	:	US
Telephone Number	:	888-803-3370
Fax Number	:	415-779-8032

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/31/2025

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Directions to “ MR. JARROD D ROUSSEL PA.-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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