MEDICARE: JESSIKA L ROSER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033574165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIKA L ROSER PA-C

Provider Business Mailing Address
First Line	:	711 S DALE MABRY HWY STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4400
Country	:	US
Telephone Number	:	813-548-7860
Fax Number	:	813-605-6156

Provider Business Practice Location Address
First Line	:	711 S DALE MABRY HWY STE 201
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4400
Country	:	US
Telephone Number	:	813-548-7860
Fax Number	:	813-605-6156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	04/13/2023

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Directions to “ JESSIKA L ROSER PA-C” Practice Location

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