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General NPI Number Information
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NPI Number | 1578930731
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Entity Type | Individual
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Provider Name | JARED K FIFE PA
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Gender | Male
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 880 SW 145TH AVE STE 202
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-6171
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Country | US
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Telephone | 866-849-0692
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Fax |
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Provider Business Mailing Address
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Address Line | 5414 MERLIN WAY
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City | MILTON
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State | FL
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Zip | 32583-5658
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Country | US
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Telephone | 208-740-9266
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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 | 54155
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9491002-1206
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9116275
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License Number State | FL
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