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Jessica Petrov

Internal Medicine

Allopathic & Osteopathic Physicians

4500 San Pablo Rd S # 226, Jacksonville, FL 32224-1865

(904) 953-2000

PECOS Enrollment

Based on the most recent information from CMS, provider Jessica Petrov is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1508495771
Provider Type
Individual
Full Name
Petrov, Jessica
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
4/8/2020
Last Updated
7/7/2023

Contact Information

Practice Location

4500 San Pablo Rd S # 226, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Mailing Location

4500 San Pablo Rd S # 226, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207RG0100X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License ME160732 Florida

Jessica Petrov

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Ghoz, Hassan

Pang, Maoyin

Cangemi, John

Osagiede, Osayande

Keaveny, Andrew

Stark, Mark

Loeb, Lauren Piper

Olson, Caroline Grace

Laoveeravat, Passisd

Farraye, Francis A