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General NPI Number Information
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NPI Number | 1649465857
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Entity Type | Individual
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Provider Name | JESSICA BASTOS OLIVEIRA MSPA, PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11200 SW 8 STREET GREEN LIBRARY, ROOM 475
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City | MIAMI
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State | FL
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Zip | 33199-3319
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Country | US
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Telephone | 917-495-1632
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Fax | 917-495-1632
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Provider Business Mailing Address
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Address Line | 7421 SW 163RD CT
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City | MIAMI
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State | FL
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Zip | 33193-4422
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Country | US
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Telephone | 917-495-1632
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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 | 0119001
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License Number State | NY
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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 | PA9109706
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License Number State | FL
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