Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME0040086 | FL |
NPI | 1003907577 |
---|---|
Provider Name | Dr. Patricia Ann Jasionowski |
First Address | Venice, FL 34285-2418 |
Second Address | Venice, FL 34285-2418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58376 | BLUE CROSS/SHIELD (01) | |
592326366 | COMMERCIAL (01) | |
592326366 | HMO (01) | |
592326366 | PPO (01) | |
D21792 | (02) | FL |
FS0988160 | TRICARE (01) |