Provider Demographics
NPI:1649553587
Name:HAGE, JESSICA M (PA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:M
Last Name:HAGE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4200 N ARMENIA AVE
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6438
Mailing Address - Country:US
Mailing Address - Phone:813-877-4811
Mailing Address - Fax:
Practice Address - Street 1:4200 N ARMENIA AVE
Practice Address - Street 2:SUITE 1-2
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6438
Practice Address - Country:US
Practice Address - Phone:813-877-4811
Practice Address - Fax:813-870-2851
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2014-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9106165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical