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General NPI Number Information
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NPI Number | 1497975130
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Entity Type | Individual
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Provider Name | JESSICA DIFO PA
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1 TAMPA GENERAL CIR TGH INTERVENTIONAL RADIOLOGY
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City | TAMPA
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State | FL
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Zip | 33606-3571
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Country | US
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Telephone | 813-844-4570
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Fax | 813-844-4032
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Provider Business Mailing Address
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Address Line | 2700 UNIVERSITY SQUARE DR RADIOLOGY ASSOC OF TAMPA
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City | TAMPA
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State | FL
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Zip | 33612-5513
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Country | US
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Telephone | 813-251-5822
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 9103704
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License Number State | FL
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