Provider Demographics
NPI:1841225083
Name:RICE, JENNIFER L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:RICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15051 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:23471 WALDEN CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34134-5016
Practice Address - Country:US
Practice Address - Phone:239-498-3376
Practice Address - Fax:239-498-3379
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105815363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant