MEDICARE: MRS. MARY KATHERINE JAWORSKI 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	PA9107931	FL

General Provider Information

NPI Number	:	1962783589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHERINE JAWORSKI PA-C

Provider Business Mailing Address
First Line	:	7448 VENETIAN WAY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406
Country	:	US
Telephone Number	:	717-793-0253
Fax Number	:	954-949-2111

Provider Business Practice Location Address
First Line	:	3313 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BCH
State	:	FL
Zip	:	33442-9423
Country	:	US
Telephone Number	:	949-954-2100
Fax Number	:	954-949-2111

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	02/05/2019

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