MEDICARE: DR. PATRICIA JAEGERMAN PSY.D.

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	103TC0700X	Clinical Psychologist	7141	FL
2	103TF0000X	Family Psychologist	7141	FL

General Provider Information

NPI Number	:	1316272677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA JAEGERMAN PSY.D.

Provider Business Mailing Address
First Line	:	2450 HOLLYWOOD BLVD
Second Line	:	SUITE 200A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6619
Country	:	US
Telephone Number	:	954-667-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 HOLLYWOOD BLVD
Second Line	:	SUITE 200A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6619
Country	:	US
Telephone Number	:	954-667-7176
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	04/17/2012

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