Provider Demographics
NPI:1053486118
Name:LYNCH RIGGS, JENNIFER JAYNE (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JAYNE
Last Name:LYNCH RIGGS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNCH
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
9371395OtherAETNA PIN
AL592-08975OtherBLUE CROSS BLUE SHIELD
AL59197546OtherBCBS ALABAMA
AL59197955OtherBCBS ALABAMA - GBO
AL114287Medicaid
FLP00397341OtherMEDICARE RAILROAD
FLY01JGOtherBLUE CROSS BLUE SHIELD
AL114287Medicaid
FLAD231YMedicare PIN
AL59197955OtherBCBS ALABAMA - GBO
AL59197546OtherBCBS ALABAMA