Provider Demographics
NPI:1821322926
Name:BATTISTONI, JARED (PA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BATTISTONI
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 1:2020 OAKLEY SEAVER DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1902
Mailing Address - Country:US
Mailing Address - Phone:352-242-0404
Mailing Address - Fax:352-242-0877
Practice Address - Street 1:2020 OAKLEY SEAVER DR STE 3
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1902
Practice Address - Country:US
Practice Address - Phone:352-242-0404
Practice Address - Fax:352-242-0877
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant