Provider Demographics
NPI:1407519176
Name:ADAM, JESSICA ALEJANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ALEJANDRA
Last Name:ADAM
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 1:3255 NE 184TH ST
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4989
Mailing Address - Country:US
Mailing Address - Phone:305-244-7030
Mailing Address - Fax:
Practice Address - Street 1:3255 NE 184TH ST APT 12117
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4990
Practice Address - Country:US
Practice Address - Phone:305-244-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9115104207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine