Healthcare Provider Details

I. General information

NPI: 1255986428
Provider Name (Legal Business Name): ANAM JAFFAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S ALAFAYA TRL STE 26
ORLANDO FL
32828-8984
US

IV. Provider business mailing address

7560 RED BUG LAKE RD STE 1014
OVIEDO FL
32765-6591
US

V. Phone/Fax

Practice location:
  • Phone: 407-538-3855
  • Fax:
Mailing address:
  • Phone: 407-706-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9112115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: