Provider Demographics
NPI:1902820707
Name:FLETCHER, JAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 SW 32ND PL STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7163
Mailing Address - Country:US
Mailing Address - Phone:352-732-9643
Mailing Address - Fax:352-732-5952
Practice Address - Street 1:2685 SW 32ND PL STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7163
Practice Address - Country:US
Practice Address - Phone:352-732-9643
Practice Address - Fax:352-732-5952
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS87973Medicare UPIN
FLE2969XMedicare ID - Type Unspecified