Individual
JENNIFER R WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
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) 532-2411
(305) 532-9793
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9101701
FL
Other
Enumeration date
08/19/2006
Last updated
12/08/2014
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