Individual
JENNIFER KOELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 DOCTORS CT, LEESBURG, FL 34748-7314
(352) 787-9838
(352) 787-8705
Mailing address
PO BOX 3130, OCALA, FL 34478-3130
(352) 867-3262
(352) 622-5771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00337400
NJ
363AS0400X
Surgical Physician Assistant
Primary
PA9108194
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117870300
—
FL
01
—
PA9108194
MEDICAL LICENSE
FL
01
—
UM361
MEDICARE HF
FL
Enumeration date
06/30/2014
Last updated
04/01/2025
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