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General NPI Number Information
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NPI Number | 1821979279
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Entity Type | Individual
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Provider Name | JENNA SHORTRIDGE PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 9401 SW DISCOVERY WAY STE 101
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2381
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Country | US
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Telephone | 772-261-6824
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Fax |
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Provider Business Mailing Address
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Address Line | 7422 ASHLEY SHORES CIR
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City | LAKE WORTH
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State | FL
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Zip | 33467-7618
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Country | US
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Telephone | 561-310-6274
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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 |
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License Number State |
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