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Individual

MRS. JACQUELINE FRISCIA HENRY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
701 6TH ST S, ST PETERSBURG, FL 33701-4814
(727) 553-7300
(727) 553-7395
Mailing address
2118 W ERNA DR, TAMPA, FL 33603-2720
(813) 317-7403

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9111840
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
102105900
FL
01
REQQT
BCBS
FL
Enumeration date
01/21/2019
Last updated
01/08/2020
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