Healthcare Provider Details

I. General information

NPI: 1427566298
Provider Name (Legal Business Name): JORDAN LIZABETH WRYE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 ATLANTIC AVE STE 100
DELRAY BEACH FL
33484-8112
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5677
  • Fax: 561-496-5824
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9111010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: