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General NPI Number Information
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NPI Number | 1548443518
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Entity Type | Individual
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Provider Name | ERIKA LEIGH JACUMIN PA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 8 MIRROR LAKE DR.
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 386-673-2500
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Fax | 386-673-2504
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Provider Business Mailing Address
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Address Line | 4041 ACOMA DR.
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City | ORMOND BEACH
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State | FL
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Zip | 32174
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Country | US
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Telephone | 316-461-0725
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Fax | 316-260-5424
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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 | 1501298
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 012303
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9109183
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License Number State | FL
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