Provider Demographics
NPI:1154498384
Name:LEVIN, JACQUELINE M (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:LEVIN
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 CATTLERIDGE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6028
Mailing Address - Country:US
Mailing Address - Phone:727-527-5272
Mailing Address - Fax:
Practice Address - Street 1:6050 CATTLERIDGE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6028
Practice Address - Country:US
Practice Address - Phone:941-365-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102538363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291798000Medicaid
FLQ46186Medicare UPIN
FL291798000Medicaid