Provider Demographics
NPI:1649354812
Name:DURCHIN, JAMIE LEE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JAMIE
Middle Name:LEE
Last Name:DURCHIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1815 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5979
Mailing Address - Country:US
Mailing Address - Phone:863-709-9392
Mailing Address - Fax:863-688-2520
Practice Address - Street 1:1409 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2528
Practice Address - Country:US
Practice Address - Phone:863-709-8543
Practice Address - Fax:863-688-2520
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109519363AM0700X
PAMA052770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
108346Q9ZMedicare PIN