MEDICARE: JENNA MARIE PARKER

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	363AS0400X	Surgical Physician Assistant	PA9117722	FL

General Provider Information

NPI Number	:	1467144337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MARIE PARKER

Provider Business Mailing Address
First Line	:	7506 SAN SEBASTIAN DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-1023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7506 SAN SEBASTIAN DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-1023
Country	:	US
Telephone Number	:	561-289-2412
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	10/26/2023

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