Broderick, Jennifer Mary

Broderick, Jennifer Mary is an individual health care provider with primary practice located at 960 7Th Ave N , St Petersburg FL 33705-1347. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Broderick, Jennifer Mary can be contacted via phone (727) 821-8101.

Contact Information

Primary practice address
960 7Th Ave N St Petersburg FL 33705-1347
Phone: (727) 821-8101
Fax: (727) 894-8360
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 9102539 Florida

Profile Details

NPI number 1962499723
LBN Legal business name Broderick, Jennifer Mary
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 5th, 2005
Last updated Mar 29th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962499723 NPPES
Florida MEDICAID 291647900

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