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General NPI Number Information
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NPI Number | 1053927962
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Entity Type | Individual
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Provider Name | JACKELINE ANDREA MARX CAA
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Gender | Female
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | 7700 W SUNRISE BLVD
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City | PLANTATION
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State | FL
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Zip | 33322-4113
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Country | US
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Telephone | 800-437-2672
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Fax |
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Provider Business Mailing Address
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Address Line | 3654 NW 85TH TER
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-5100
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Country | US
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Telephone | 305-316-1406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 615
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License Number State | FL
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