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General NPI Number Information
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NPI Number | 1407553944
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Entity Type | Individual
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Provider Name | JESSICA L FILLIPOVICH PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 501 LIVE OAK ST STE C
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7300
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Country | US
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Telephone | 386-231-3600
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Fax | 386-231-3602
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Provider Business Mailing Address
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Address Line | PO BOX 935921
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City | ATLANTA
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State | GA
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Zip | 31193-5921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9119342
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9119342
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119342
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License Number State | FL
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