Provider Demographics
NPI:1477802965
Name:THEMAK, JESSICA R (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:THEMAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 NE 1ST AVE APT 3706
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1831
Mailing Address - Country:US
Mailing Address - Phone:631-461-2750
Mailing Address - Fax:
Practice Address - Street 1:698 NE 1ST AVE APT 3706
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1831
Practice Address - Country:US
Practice Address - Phone:631-461-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114194207P00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine