Provider Demographics
NPI:1104925718
Name:WIT, JENNIFER L (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WIT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 STATE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4590
Mailing Address - Country:US
Mailing Address - Phone:850-769-1462
Mailing Address - Fax:850-249-1009
Practice Address - Street 1:2202 STATE AVE STE 303
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4590
Practice Address - Country:US
Practice Address - Phone:850-769-1462
Practice Address - Fax:850-249-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3095ZMedicare UPIN
FLU30954Medicare UPIN