Provider Demographics
NPI:1942262001
Name:FLOYD, JAMIE ALISSA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ALISSA
Last Name:FLOYD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ALISSA
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7004 SMITH CORNERS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3793
Mailing Address - Country:US
Mailing Address - Phone:704-688-9650
Mailing Address - Fax:704-688-9651
Practice Address - Street 1:7004 SMITH CORNERS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3793
Practice Address - Country:US
Practice Address - Phone:704-688-9650
Practice Address - Fax:704-688-9651
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P59790Medicare UPIN