MEDICARE: JERRED NEMERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9114071	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104419910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRED NEMERSON PA-C

Provider Business Mailing Address
First Line	:	6280 W SAMPLE RD STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3173
Country	:	US
Telephone Number	:	561-322-3588
Fax Number	:	754-812-5993

Provider Business Practice Location Address
First Line	:	6280 W SAMPLE RD STE 202
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3173
Country	:	US
Telephone Number	:	561-322-3588
Fax Number	:	754-812-5993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	07/05/2022

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