MEDICARE: DR. JESSICA G RAUSCH MD

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	2084P0800X	Psychiatry Physician	ME0044809	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	592913087336140000	OTHER		CHAMPUS
2	30735	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1730279159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA G RAUSCH MD

Provider Business Mailing Address
First Line	:	14502 N DALE MABRY HWY STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2043
Country	:	US
Telephone Number	:	813-931-7022
Fax Number	:	813-931-7123

Provider Business Practice Location Address
First Line	:	14502 N DALE MABRY HWY STE 328
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2043
Country	:	US
Telephone Number	:	813-931-7022
Fax Number	:	813-931-7123

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

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	01/02/2023

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