Individual
MR. JESSIE ENRIQUE GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
220 HOVEY RD FL 1047, PENSACOLA, FL 32508-1047
(619) 339-2536
Mailing address
220 HOVEY RD FL 1047, PENSACOLA, FL 32508-1047
(619) 339-2536
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 13618
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13618
STATE LICENSE
CA
Enumeration date
01/24/2007
Last updated
03/31/2020
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