JACQUELINE INDRISEK PA NPI 1427442011

NPI Information

  • NPI: 1427442011
  • Provider Name: JACQUELINE INDRISEK, PA
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • Address: 22655 BAYSHORE RD STE 130
    PORT CHARLOTTE, FL
    ZIP 33980
  • Phone: (941) 255-3722

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NPI Details

Jacqueline Indrisek, PA is a medical physician assistant in Port Charlotte, FL. Jacqueline Indrisek, PA NPI is 1427442011. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

22655 BAYSHORE RD STE 130
PORT CHARLOTTE, FL
ZIP 33980-005
Phone: (941) 255-3722
Fax: (941) 255-3723

The enumeration date for this NPI number is 3/23/2015 and was last updated on 6/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalPA9108209FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1014722900MEDICAIDFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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