Provider Demographics
NPI:1730279159
Name:RAUSCH, JESSICA G (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:G
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 N DALE MABRY HWY STE 328
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2043
Mailing Address - Country:US
Mailing Address - Phone:813-931-7022
Mailing Address - Fax:813-931-7123
Practice Address - Street 1:14502 N DALE MABRY HWY STE 328
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2043
Practice Address - Country:US
Practice Address - Phone:813-931-7022
Practice Address - Fax:813-931-7123
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00448092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
592913087336140000OtherCHAMPUS
30735OtherBLUE CROSS BLUE SHIELD
FL307352Medicare ID - Type Unspecified
592913087336140000OtherCHAMPUS