Most Relevant Information
Provider Data
| NPI Number: | 1003271404 |
| Provider Name: | JESSICA DEFAZIO PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9113468 |
Most Important Dates
| Enumeration Date: | 12/30/2015 |
| Last Updated: | 01/24/2024 |
Provider Practice Location
800 PRUDENTIAL DR STE 1100
JACKSONVILLE
FL
322078202
Practice Location Phone/Fax
| Phone: | 9043886518 |
| Fax: | 9043841005 |
Provider Mailing Location
PO BOX 746647
ATLANTA
GA
303746647
Provider Mailing Phone/Fax
| Phone: | 9043886518 |
| Fax: | 9043841005 |