Healthcare Provider Details

I. General information

NPI: 1043808157
Provider Name (Legal Business Name): ANAEL DJAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

3051 BIRD LN
WINDERMERE FL
34786-8349
US

V. Phone/Fax

Practice location:
  • Phone: 954-423-9234
  • Fax:
Mailing address:
  • Phone: 407-765-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9116410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: