Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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MS. Jessica Marie Tacconelli, PA-C

Individual provider Medical Physician Assistant · NPI 1164791752

MS. Jessica Marie Tacconelli, PA-C is a Physician Assistant in West Bloomfield, Michigan. Qualified in 2011, 15 years ago. Practices with Midwest Center for Dermatology and Pathology PLLC, a 49-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
15
Licensed in
MI
In the registry since
2011
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

6330 Orchard Lake Rd Ste 120
West Bloomfield, MI 48322
Phone: (248) 855-3366
Fax: (248) 855-6213
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 5601006221 (MI)

Record details

NPI number1164791752
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 28, 2011
Last updated in NPPESDecember 28, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Midwest Center For Dermatology And Pathology Pllc — 49 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in West Bloomfield