Healthcare Provider Details

I. General information

NPI: 1659994259
Provider Name (Legal Business Name): JESSICA LYNN HAMILTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN GARBER

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E EDGEWOOD DR STE 112
LAKELAND FL
33803-3639
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

V. Phone/Fax

Practice location:
  • Phone: 863-666-3436
  • Fax:
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: