Provider Demographics
NPI:1538301957
Name:LOCCHEAD, JESSICA L (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:LOCCHEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4511 N DAVIS HWY S
Mailing Address - Street 2:STE1-C
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2770
Mailing Address - Country:US
Mailing Address - Phone:850-477-3252
Mailing Address - Fax:850-477-2659
Practice Address - Street 1:4511 N DAVIS HWY
Practice Address - Street 2:STE 1-C
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2720
Practice Address - Country:US
Practice Address - Phone:850-477-3252
Practice Address - Fax:850-477-2659
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant