MEDICARE: MR. JEREMY S. WILBANKS 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

General Provider Information

NPI Number	:	1598096810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY S. WILBANKS PA-C

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 MONUMENT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-7411
Country	:	US
Telephone Number	:	904-727-5151
Fax Number	:	904-727-5180

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

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	08/19/2022

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Directions to “ MR. JEREMY S. WILBANKS PA-C” Practice Location

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