Most Relevant Information
Provider Data
| NPI Number: | 1003432360 |
| Provider Name: | JENNIFER ROSE BAKER KOEBERT PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 0010-10048 |
Most Important Dates
| Enumeration Date: | 06/23/2020 |
| Last Updated: | 06/23/2020 |
Provider Practice Location
4001 E FLETCHER AVE FL 6
TAMPA
FL
336134808
Practice Location Phone/Fax
| Phone: | 8133960768 |
| Fax: |
Provider Mailing Location
4916 EBENSBURG DR
TAMPA
FL
336471381
Provider Mailing Phone/Fax
| Phone: | 8136105669 |
| Fax: |