Provider Demographics
NPI:1568851699
Name:INCHERCHERA, SALLYANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SALLYANN
Middle Name:
Last Name:INCHERCHERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SALLYANN
Other - Middle Name:
Other - Last Name:MARCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10140 CENTURION PKWY N FL PROVIDER
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-3600
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:8934 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3128
Practice Address - Country:US
Practice Address - Phone:407-351-0082
Practice Address - Fax:407-374-1637
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003462363A00000X
PAMA057324363A00000X
FLPA9109220363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical