Organization
JENNIFER WAGNER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WAGNER PA (OWNER)
(305) 987-4443
Entity
Organization
Contact information
Practice address
20201 NE 21ST AVE, MIAMI, FL 33179-2804
(305) 987-4443
Mailing address
20201 NE 21ST AVE, MIAMI, FL 33179-2804
(305) 987-4443
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9101701
FL
Other
Enumeration date
03/24/2015
Last updated
03/24/2015
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