Provider Demographics
NPI:1538491717
Name:PRIMOSCH, JAMIE (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PRIMOSCH
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1737
Mailing Address - Country:US
Mailing Address - Phone:404-766-8371
Mailing Address - Fax:
Practice Address - Street 1:12509 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-4119
Practice Address - Country:US
Practice Address - Phone:404-376-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063354363AM0700X
FLPA9106454363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical