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NPI Code Detail

MEDICARE: JENNIFER L LANG PA-C

MEDICARE: JENNIFER L LANG 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
1363AS0400XSurgical Physician AssistantPA9102077FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1TM157OTHERFLMEDICARE HF

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417912494
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER L LANG PA-C
Provider Business Mailing Address
First Line : 3300 S FISKE BLVD
Second Line :
City : ROCKLEDGE
State : FL
Zip : 32955-4306
Country : US
Telephone Number : 321-434-8078
Fax Number :
Provider Business Practice Location Address
First Line : 1425 MALABAR RD NE
Second Line :
City : PALM BAY
State : FL
Zip : 32907-2506
Country : US
Telephone Number : 321-434-8078
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 10/02/2025

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Directions to “ JENNIFER L LANG PA-C” Practice Location

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