Provider Demographics
NPI:1518148642
Name:WEGMANN, JESSICA TOMLINSON (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:TOMLINSON
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-667-1891
Mailing Address - Fax:843-665-2516
Practice Address - Street 1:101 WILLIAM H. JOHNSON STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2733
Practice Address - Country:US
Practice Address - Phone:843-667-1891
Practice Address - Fax:843-665-2516
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1277363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant