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General NPI Number Information
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NPI Number | 1134477490
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Entity Type | Individual
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Provider Name | JENNIFER MARIE WADE PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 10301 HAGEN RANCH RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3724
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Country | US
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Telephone | 954-581-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 VILLA JUNO DR S
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City | JUNO BEACH
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State | FL
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Zip | 33408-2402
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Country | US
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Telephone | 908-565-1079
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115997
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015862
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License Number State | NY
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