Individual
JENNIFER BUTTERFIELD BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1651 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7564
(772) 398-1800
(770) 398-1815
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5653
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9108965
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021744000
—
FL
01
—
KHX57
FLORIDA BLUE
FL
Enumeration date
03/22/2016
Last updated
11/06/2020
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