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JACQUELINE INDRISEK PA
NPI 1427442011
Physician Assistant - Medical in Port Charlotte, FL

Active since March 23, 2015PECOS Enrolled
22655 BAYSHORE RD STE 130, PORT CHARLOTTE, FL 33980(941) 255-3722(941) 255-3723 Get Directions Write a Review

NPPES record last updated: June 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 7, 2023, Feb 9, 2022, Jun 25, 2021 (3 updates tracked since 2021).

About Jacqueline Indrisek Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUELINE INDRISEK PA (NPI 1427442011) is an individual medical provider in Port Charlotte, Florida, licensed in Florida (PA9108209) and active in the NPI registry since March 2015. She is enrolled in Medicare PECOS and maintains a secondary practice location in Fort Myers.

NPPES Registry Identity

NPI1427442011
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameJACQUELINE INDRISEKCredential: PA
Location Address22655 BAYSHORE RD STE 130Port Charlotte, FL 33980-2005
Mailing AddressPo Box 2147Fort Myers, FL 33902-2147 · (941) 255-3722 · Fax (941) 255-3723
Phone(941) 255-3722
Fax(941) 255-3723
Sole ProprietorNo
Enumeration DateMarch 23, 2015
Last NPPES UpdateJune 7, 20233 updates tracked since enumeration
NPPES CertifiedJune 7, 2023
✔ NPI 1427442011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in FL · PA9108209
22655 BAYSHORE RD STE 130, Port Charlotte, FL 33980
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Secondary Practice Location 1

Location 18260 Gladiolus DrFort Myers, FL 33908-4156 · Phone (239) 437-5755 · Fax (239) 437-5776

Other Identifiers 1

Medicaid014722900FL

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Indrisek Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. AMANDA K HUFFMAN APRN
Nurse Practitioner (Family)
22655 BAYSHORE RD STE 130
PORT CHARLOTTE, FL 33980
Charlotte County (941) 255-3722

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Indrisek's NPI number?

The NPI number for Jacqueline Indrisek is 1427442011. It was assigned to this individual provider in the NPPES registry on March 23, 2015.

Where is Jacqueline Indrisek located?

Jacqueline Indrisek practices at 22655 Bayshore Rd Ste 130, Port Charlotte, FL 33980. The listed phone number is (941) 255-3722.

What is Jacqueline Indrisek's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jacqueline Indrisek enrolled in Medicare?

Yes. Jacqueline Indrisek is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Indrisek was last updated on June 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.