MEDICARE: JENNIFER JO PASSANTINO P.A.-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	659	SC

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	:	1952368037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JO PASSANTINO P.A.-C

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 FRESHFIELDS DRIVE
Second Line	:	SUITE J101
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-6323
Country	:	US
Telephone Number	:	843-768-4800
Fax Number	:	843-606-8039

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	05/11/2021

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