MEDICARE: MRS. JAMIE ALISSA FLOYD 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	103482	NC

General Provider Information

NPI Number	:	1942262001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE ALISSA FLOYD PA-C

Provider Business Mailing Address
First Line	:	7004 SMITH CORNERS BLVD
Second Line	:	SUITE A
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3793
Country	:	US
Telephone Number	:	704-688-9650
Fax Number	:	704-688-9651

Provider Business Practice Location Address
First Line	:	7004 SMITH CORNERS BLVD
Second Line	:	SUITE A
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3793
Country	:	US
Telephone Number	:	704-688-9650
Fax Number	:	704-688-9651

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	05/06/2011

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