Jaclyn Marie Pennington Ortega, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 9105851 Issued in FL

Practice address

204 E 19TH St
Panama City, FL 32405-4707

Phone

(850) 763-5409

NPI assigned

Dec 20, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jortega@landmarkhealth-direct.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maria U Tedtaotao MD PA

  dba Zoe Family Care Clinic

  • Family Medicine Physician
  • Lynn Haven, FL
  • NPI 1083867295
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1316216492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 E LAKELAND DR",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324045219",
            "telephone_number": "850-625-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 E 19TH ST",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054707",
            "telephone_number": "850-763-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON ORTEGA",
        "first_name": "JACLYN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-20",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9105851",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lynn Pelt, APRN-C
• Anita M. Pembleton, LMHC
• Jesse Curtis Pendergrast, CRNA
• Thomas Lee Pendergrast, O.D.
• Leslie Annis Pennel, RN
• Toni Pennington, M.D.
• Peoples Hospice and Palliative Care of NW Florida LLC (Peoples Hospice and Palliative Care)
• Genesis Lyn Peoples
• Michelle Terrell Peoples
• Sandra Denise Percy-Smith

• Physician Assistant in Panama City, FL
• Providers in Panama City, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.