Individual
JENIFER D LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
906 PARK AVE, ORANGE PARK, FL 32073-4120
(904) 541-0315
(904) 541-0316
Mailing address
PO BOX 160295, ALTAMONTE SPRINGS, FL 32716-0295
(904) 541-0315
(904) 541-0316
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9106797
FL
363AS0400X
Surgical Physician Assistant
PA9106797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9106797
PA LICENSE
FL
Enumeration date
11/09/2012
Last updated
05/17/2019
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