Provider Demographics
NPI:1427092360
Name:WETHINGTON, JENNIFER N (PA-C, MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:N
Last Name:WETHINGTON
Suffix:
Gender:F
Credentials:PA-C, MS
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:KHONSARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C,MS
Mailing Address - Street 1:12416 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3437
Mailing Address - Country:US
Mailing Address - Phone:727-547-4700
Mailing Address - Fax:727-394-8661
Practice Address - Street 1:12416 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3437
Practice Address - Country:US
Practice Address - Phone:727-547-4700
Practice Address - Fax:727-394-8661
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49990YMedicare ID - Type Unspecified
FLP62899Medicare UPIN