Indrisek, Jacqueline

Indrisek, Jacqueline is an individual health care provider with primary practice located at 22655 Bayshore Rd Ste 130 , Port Charlotte FL 33980-2005. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Indrisek, Jacqueline can be contacted via phone (941) 255-3722.

Contact Information

Primary practice address
22655 Bayshore Rd Ste 130 Port Charlotte FL 33980-2005
Phone: (941) 255-3722
Fax: (941) 255-3723
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9108209 Florida

Profile Details

NPI number 1427442011
LBN Legal business name Indrisek, Jacqueline
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2015
Last updated Jun 7th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427442011 NPPES
Florida MEDICAID 014722900

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