Provider Demographics
NPI:1417473117
Name:REMAVICH, JESSICA B (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:REMAVICH
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 1:5163 NW 58TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2144
Mailing Address - Country:US
Mailing Address - Phone:307-331-0114
Mailing Address - Fax:
Practice Address - Street 1:7171 N UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2902
Practice Address - Country:US
Practice Address - Phone:954-718-7776
Practice Address - Fax:954-597-7773
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9110515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant