Healthcare Provider Details

I. General information

NPI: 1295286771
Provider Name (Legal Business Name): JACOB CERNY-GARCIA C-AA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 04/12/2022
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

621 NE 28TH ST APT 2
WILTON MANORS FL
33334-2545
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 305-308-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA 356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: