Individual
MRS. JENNIFER MARY BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
960 7TH AVE N, ST PETERSBURG, FL 33705-1347
(727) 821-8101
(727) 894-8360
Mailing address
960 7TH AVE N, ST PETERSBURG, FL 33705-1347
(727) 821-8101
(727) 894-8360
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
9102539
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291647900
—
FL
Enumeration date
10/05/2005
Last updated
03/29/2013
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