# PROFESSIONAL SURGICAL ASSISTANTS

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

## Provider details

- **NPI number:** 1740618974
- **Authorized official:** JACKI M RENTA (CREDENTIALING)
- **Authorized official phone:** (954) 382-2930

## Contact information

- **Practice address:** 300 S PINE ISLAND RD, 105, PLANTATION, FL 33324-2673
- **Practice address phone:** (954) 382-2930
- **Mailing address:** 10190 SW 3RD ST, PLANTATION, FL 33324-2234
- **Mailing address phone:** (954) 382-2930

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA9107526 | FL | Yes |

## Other

- **Enumeration date:** 10/25/2013
- **Last updated:** 10/25/2013