Healthcare Provider Details

I. General information

NPI: 1134420003
Provider Name (Legal Business Name): JESSICA P. KOFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA P. MUNOZ PA-C

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 02/12/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2985 DREW ST
CLEARWATER FL
33759-3012
US

IV. Provider business mailing address

3027 SHEEHAN DR
LAND O LAKES FL
34638-8029
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: