Provider Demographics
NPI:1336548395
Name:WHITMAN, JESSICA (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JAMROGOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7402 HEATHLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:856-912-1173
Mailing Address - Fax:610-226-6201
Practice Address - Street 1:5503 S CONGRESS AVENUE SUITE 204
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-410-5110
Practice Address - Fax:856-433-6201
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00342800363A00000X
FLPA9109550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant