Provider Demographics
NPI:1245705862
Name:COFFEE, JODIANNE C (PA-C)
Entity type:Individual
Prefix:
First Name:JODIANNE
Middle Name:C
Last Name:COFFEE
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 1:201 4TH ST S UNIT 407
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4290
Mailing Address - Country:US
Mailing Address - Phone:727-667-3033
Mailing Address - Fax:
Practice Address - Street 1:27001 US HIGHWAY 19 N STE 1033B
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3407
Practice Address - Country:US
Practice Address - Phone:727-726-1962
Practice Address - Fax:727-726-1606
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant