MEDICARE: JAXOMS, P.A.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1992634612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAXOMS, P.A.

Provider Business Mailing Address
First Line	:	9900 STIRLING RD STE 300
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8066
Country	:	US
Telephone Number	:	402-805-4516
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 STIRLING RD STE 300
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33024-8066
Country	:	US
Telephone Number	:	402-805-4516
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JENN HERITAGE
Credential	:
Telephone Number	:	402-805-4516

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/19/2026

Similar Medicare Providers

1356201735 — MY SKIN CARE NOW ,PLLC
Practice Location Address:

9900 STIRLING RD STE 301
COOPER CITY, FL
33024-8066

Practice Phone: 754-207-0790
Practice Fax:

1972430700 — BROOKE STARK
Practice Location Address:

7715 NE 103RD TER
KANSAS CITY, MO
64157-8066

Practice Phone: 816-776-9553
Practice Fax:

1528630167 — SHABNAM SHAMSUDDIN
Practice Location Address:

34511 TORREY PINE LN
UNION CITY, CA
94587-8066

Practice Phone: 408-612-6598
Practice Fax:

1881452704 — INGRID ISABEL HERNANDEZ APRN
Practice Location Address:

9900 STIRLING RD STE 301
HOLLYWOOD, FL
33024-8066

Practice Phone: 754-207-0790
Practice Fax:

1104894575 — PROGRESSIVE ORTHOPEDIC AND REHABILITATION INC
Practice Location Address:

9900 STIRLING RD STE 303
HOLLYWOOD, FL
33024-8066

Practice Phone: 954-432-8872
Practice Fax: 954-432-9913

1295897536 — PALM REHABILITATION CENTER, INC.
Practice Location Address:

9900 STIRLING RD STE 303
HOLLYWOOD, FL
33024-8066

Practice Phone: 954-432-8872
Practice Fax: 954-432-9913

Directions to “JAXOMS, P.A. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.