Healthcare Provider Details

I. General information

NPI: 1134477490
Provider Name (Legal Business Name): JENNIFER MARIE WADE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N FEDERAL HWY STE 200
FORT LAUDERDALE FL
33308-4611
US

IV. Provider business mailing address

110 E PIGEON PLUM DR APT 108
JUPITER FL
33458-7867
US

V. Phone/Fax

Practice location:
  • Phone: 954-688-7269
  • Fax:
Mailing address:
  • Phone: 908-565-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115997
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015862
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: