Healthcare Provider Details

I. General information

NPI: 1679083919
Provider Name (Legal Business Name): JENNIFER NICOLE KASZUBSKI PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2017
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W CYPRESS CREEK RD STE C100
FORT LAUDERDALE FL
33309-1741
US

IV. Provider business mailing address

9632 WATERVIEW WAY
PARKLAND FL
33076-2898
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-3111
  • Fax: 954-974-6191
Mailing address:
  • Phone: 845-258-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110648
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9110648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: