Healthcare Provider Details

I. General information

NPI: 1689147795
Provider Name (Legal Business Name): JENNIFER LEIZEROVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE FEDERAL HWY STE 334
STUART FL
34994-3839
US

IV. Provider business mailing address

1111 SE FEDERAL HWY STE 334
STUART FL
34994-3839
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 239-690-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: