MEDICARE: JENNIFER PANTALEO 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	363A00000X	Physician Assistant	PA 9107892	FL

General Provider Information

NPI Number	:	1285045401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PANTALEO PA-C

Provider Business Mailing Address
First Line	:	16601 PALM COAST CT
Second Line	:	APT 633
City	:	TAMPA
State	:	FL
Zip	:	33647-2693
Country	:	US
Telephone Number	:	727-251-9786
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 ARGERIAN DR
Second Line	:	#103
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33545-4140
Country	:	US
Telephone Number	:	813-991-4991
Fax Number	:

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	05/09/2014

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