Healthcare Provider Details

I. General information

NPI: 1467608273
Provider Name (Legal Business Name): JENNIFER L. DEMERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 07/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST SUITE 504
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

2446 S TAMIAMI TRL
SARASOTA FL
34239-3809
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8525
  • Fax: 941-917-2928
Mailing address:
  • Phone: 941-957-1500
  • Fax: 941-957-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: