Provider Demographics
NPI:1265748438
Name:STINEBECK, JARED C (PA-C)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:C
Last Name:STINEBECK
Suffix:
Gender:M
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 1:3100 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4613
Mailing Address - Country:US
Mailing Address - Phone:813-971-6000
Mailing Address - Fax:813-972-5753
Practice Address - Street 1:12479 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0913
Practice Address - Country:US
Practice Address - Phone:813-972-4199
Practice Address - Fax:813-972-5753
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002713000Medicaid
FLDQ379YMedicare PIN
FL002713000Medicaid