Provider Demographics
NPI:1598123457
Name:HEDGES, JEFFREY TODD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:HEDGES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PINELLAS ST STE 325
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3320
Mailing Address - Country:US
Mailing Address - Phone:727-298-6121
Mailing Address - Fax:727-298-6151
Practice Address - Street 1:1002 N CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1447
Practice Address - Country:US
Practice Address - Phone:336-580-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113430363A00000X, 363AS0400X
NC0010-06254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108683300Medicaid