Provider Demographics
NPI:1568955441
Name:UMLAND, JARED H (PA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:H
Last Name:UMLAND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 420
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-353-5360
Mailing Address - Fax:843-353-5363
Practice Address - Street 1:920 DOUG WHITE DR STE 420
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-353-5360
Practice Address - Fax:843-353-5363
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3352363A00000X
ARPA-790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant