# JENNIFER WAGNER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467846956
- **Authorized official:** JENNIFER WAGNER PA (OWNER)
- **Authorized official phone:** (305) 987-4443

## Contact information

- **Practice address:** 20201 NE 21ST AVE, MIAMI, FL 33179-2804
- **Practice address phone:** (305) 987-4443
- **Mailing address:** 20201 NE 21ST AVE, MIAMI, FL 33179-2804
- **Mailing address phone:** (305) 987-4443

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA9101701 | FL | Yes |

## Other

- **Enumeration date:** 03/24/2015
- **Last updated:** 03/24/2015