Healthcare Provider Details

I. General information

NPI: 1710125984
Provider Name (Legal Business Name): JAIME HARVEY P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 SE CENTRAL PKWY
STUART FL
34994-3904
US

IV. Provider business mailing address

969 SE CENTRAL PKWY
STUART FL
34994-3904
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-0109
  • Fax:
Mailing address:
  • Phone: 561-319-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: