Provider Demographics
NPI:1790766939
Name:JONES, SEEMA (PAC)
Entity Type:Individual
Prefix:MRS
First Name:SEEMA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4172
Mailing Address - Country:US
Mailing Address - Phone:321-456-5688
Mailing Address - Fax:321-751-9362
Practice Address - Street 1:7125 MURRELL RD
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-242-8790
Practice Address - Fax:321-751-9362
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY09Z9OtherFLORIDA BLUE
FL292548600Medicaid
FL9228859OtherAETNA
FLU6347YMedicare PIN
FLQ56336Medicare UPIN