Individual
JARED DEVIRGILIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
206 2ND ST E, BRADENTON, FL 34208-1042
(941) 746-5111
(941) 745-7233
Mailing address
367 S. GULPH RD, ATTN: IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(941) 746-5111
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA 9109796
FL
Other
Enumeration date
09/26/2016
Last updated
05/21/2019
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