Provider Demographics
NPI:1083678171
Name:BISSON, JENNIFER ENGLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ENGLE
Last Name:BISSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8990 NAVARRE PARKWAY
Mailing Address - Street 2:FAMILY MEDICINE DEPARTMENT
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566
Mailing Address - Country:US
Mailing Address - Phone:850-396-0108
Mailing Address - Fax:850-939-4933
Practice Address - Street 1:8990 NAVARRE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2157
Practice Address - Country:US
Practice Address - Phone:850-396-0108
Practice Address - Fax:850-939-4933
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9102731363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292359900Medicaid
FLY0116OtherBCBSFL
FLY0116OtherBCBSFL
FLY0116OtherBCBSFL