Provider Demographics
NPI:1538134721
Name:ROUSSEL, JARROD D (PA-C)
Entity type:Individual
Prefix:MR
First Name:JARROD
Middle Name:D
Last Name:ROUSSEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 MEADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-2356
Mailing Address - Country:US
Mailing Address - Phone:850-400-4245
Mailing Address - Fax:
Practice Address - Street 1:315 DEADERICK ST STE 1550
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37238-3003
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:415-779-8032
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110302363A00000X
TNPA0000001012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKN153OtherMEDICARE
TN3720420OtherMEDICARE