Healthcare Provider Details

I. General information

NPI: 1275557217
Provider Name (Legal Business Name): JENNIFER SUSAN MORIARTY LOEVEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MANATEE AVE E
BRADENTON FL
34208-1932
US

IV. Provider business mailing address

232 MANATEE AVE E
BRADENTON FL
34208-1932
US

V. Phone/Fax

Practice location:
  • Phone: 941-254-4957
  • Fax:
Mailing address:
  • Phone: 941-254-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0584
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9117211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: