Healthcare Provider Details

I. General information

NPI: 1083998926
Provider Name (Legal Business Name): JENNIFER J HUGHES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER J GILBERTSEN PA-C

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 LAKELAND HILLS BLVD
LAKELAND FL
33805-1965
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD MANAGED CARE DEPT
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-603-6565
  • Fax: 863-904-1961
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: