MEDICARE: JESSICA R THEMAK PA

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	207P00000X	Emergency Medicine Physician	PA9114194	FL
2	363A00000X	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	:	1477802965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA R THEMAK PA

Provider Business Mailing Address
First Line	:	698 NE 1ST AVE APT 3706
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-1831
Country	:	US
Telephone Number	:	631-461-2750
Fax Number	:

Provider Business Practice Location Address
First Line	:	698 NE 1ST AVE APT 3706
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33132-1831
Country	:	US
Telephone Number	:	631-461-2750
Fax Number	:

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	12/13/2023

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Directions to “ JESSICA R THEMAK PA” Practice Location

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