MEDICARE: JASON C. GIFFORD 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	PA9110358	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558594606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON C. GIFFORD PA-C

Provider Business Mailing Address
First Line	:	6006 49TH ST N STE 310
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-2149
Country	:	US
Telephone Number	:	727-527-9779
Fax Number	:	727-522-0415

Provider Business Practice Location Address
First Line	:	6006 49TH ST N STE 310
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-2149
Country	:	US
Telephone Number	:	727-527-9779
Fax Number	:	727-522-0415

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	02/10/2022

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