Provider Demographics
NPI:1871835652
Name:RAY, JESSICA LOUISE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LOUISE
Last Name:RAY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-532-1355
Mailing Address - Fax:813-635-2613
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1259
Practice Address - Country:US
Practice Address - Phone:727-391-6296
Practice Address - Fax:813-635-7940
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2023-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9107161363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105085900Medicaid