Provider Demographics
NPI:1245427749
Name:HERR, JAMIE GRIFFIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:GRIFFIN
Last Name:HERR
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 1:14010 21ST ST
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-3915
Mailing Address - Country:US
Mailing Address - Phone:352-567-3325
Mailing Address - Fax:352-567-3385
Practice Address - Street 1:14010 21ST ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-3915
Practice Address - Country:US
Practice Address - Phone:352-567-3325
Practice Address - Fax:352-567-3385
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105359363AM0700X
FLPA9105359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical