Provider Demographics
NPI:1538491717
Name:PRIMOSCH, JAMIE (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PRIMOSCH
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6550
Mailing Address - Country:US
Mailing Address - Phone:352-559-5409
Mailing Address - Fax:
Practice Address - Street 1:12509 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-4119
Practice Address - Country:US
Practice Address - Phone:404-376-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106454363A00000X
NY027761363A00000X
TXPA18020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant