MEDICARE: JENNIFER RENEE WREN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA9103522	FL

General Provider Information

NPI Number	:	1407839616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENEE WREN PA-C

Provider Business Mailing Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 701
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-421-5586
Fax Number	:	904-389-6748

Provider Business Practice Location Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 701
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-421-5586
Fax Number	:	904-389-6748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	07/09/2007

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