Healthcare Provider Details

I. General information

NPI: 1841684487
Provider Name (Legal Business Name): JAINA MORAR MEHTA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAINA C MORAR PA-C

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 VAN DYKE RD
LUTZ FL
33558-4880
US

IV. Provider business mailing address

4651 VAN DYKE RD
LUTZ FL
33558-4880
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-1786
  • Fax: 813-321-1787
Mailing address:
  • Phone: 813-321-1786
  • Fax: 813-321-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: