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General NPI Number Information
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NPI Number | 1669717716
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Entity Type | Individual
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Provider Name | JESSICA ANN PARKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 701 6TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4814
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Country | US
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Telephone | 727-823-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 603 7TH ST S STE 360
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4732
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Country | US
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Telephone | 727-553-7300
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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 | MA055826
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License Number State | PA
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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 | PA9110329
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License Number State | FL
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