Provider Demographics
NPI:1134984347
Name:SCOTT, JENNIFER MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:SCOTT
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 1:16875 NE CAYSON ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-2209
Mailing Address - Country:US
Mailing Address - Phone:850-674-2244
Mailing Address - Fax:
Practice Address - Street 1:16875 NE CAYSON ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-2209
Practice Address - Country:US
Practice Address - Phone:850-674-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical