Organization
BLUE LION MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANA MARIE HEINZ PA-C (MANAGING DIRECTOR)
(954) 557-4140
Entity
Organization
Contact information
Practice address
3600 WASHINGTON ST, HOLLYWOOD, FL 33021-8216
(954) 773-5744
(954) 962-1994
Mailing address
PO BOX 814479, HOLLYWOOD, FL 33081-4479
(954) 773-5744
(954) 962-1994
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9101635
FL
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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