Jacqueline Indrisek, PA
Physician Assistant, Medical in Port Charlotte, FL. Individual provider (NPI-1).
NPI number1427442011
StatusActive
Last updated in NPPESJun 7, 2023
Details
- NPI
- 1427442011
- Entity type
- Individual (NPI-1)
- Name
- Jacqueline Indrisek
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 23, 2015
- Certification date
- Jun 7, 2023
- Last updated
- Jun 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA9108209 | FL | Yes |
Practice location
22655 Bayshore Rd Ste 130Port Charlotte, FL 33980-2005
Phone 941-255-3722 · Fax 941-255-3723
Mailing address
Po Box 2147Fort Myers, FL 33902-2147
Phone 941-255-3722 · Fax 941-255-3723
Other practice locations
8260 Gladiolus Dr
Fort Myers, FL 33908-4156
Fort Myers, FL 33908-4156
Phone 239-437-5755 · Fax 239-437-5776
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