MEDICARE: MRS. JESSICA MARIE BROOKS 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	PA9118985	FL

General Provider Information

NPI Number	:	1548015746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE BROOKS PA-C

Provider Business Mailing Address
First Line	:	4197 WOODLANDS PKWY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3493
Country	:	US
Telephone Number	:	813-333-1512
Fax Number	:	813-333-1561

Provider Business Practice Location Address
First Line	:	4197 WOODLANDS PKWY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3493
Country	:	US
Telephone Number	:	727-786-3810
Fax Number	:	727-786-3855

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	01/05/2026

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