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General NPI Number Information
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NPI Number | 1891163283
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Entity Type | Individual
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Provider Name | JENNIFER NICOLE MARSHALL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 9980 CENTRAL PARK BLVD N SUITE 124
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City | BOCA RATON
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State | FL
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Zip | 33428-1762
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Country | US
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Telephone | 561-372-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 633 HERITAGE DR
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City | WESTON
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State | FL
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Zip | 33326-4547
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Country | US
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Telephone | 954-701-0034
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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 | PAT9108906
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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 | PA9108906
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License Number State | FL
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