Provider Demographics
NPI:1124497334
Name:MCCARRY, JESSICA WHEELEY (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:WHEELEY
Last Name:MCCARRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S FREMONT AVE
Mailing Address - Street 2:APT 818
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2068
Mailing Address - Country:US
Mailing Address - Phone:727-410-9830
Mailing Address - Fax:
Practice Address - Street 1:1515 22ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3113
Practice Address - Country:US
Practice Address - Phone:727-895-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109022363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant