Wonderlich, Jacob Lee

Wonderlich, Jacob Lee is an individual health care provider with primary practice located at 40100 Highway 27 , Davenport FL 33837. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Wonderlich, Jacob Lee can be contacted via phone (863) 422-4971.

Contact Information

Primary practice address
40100 Highway 27 Davenport FL 33837
Phone: (863) 422-4971
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9103414 Florida

Profile Details

NPI number 1255446878
LBN Legal business name Wonderlich, Jacob Lee
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 21st, 2006
Last updated Jul 7th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255446878 NPPES
Florida MEDICAID 292248700

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