Provider Demographics
NPI:1093066516
Name:JAFFE, JASON ALEXANDRE
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALEXANDRE
Last Name:JAFFE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 59TH ST W
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4616
Mailing Address - Country:US
Mailing Address - Phone:941-794-5621
Mailing Address - Fax:941-761-1532
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:SUITE 2200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4616
Practice Address - Country:US
Practice Address - Phone:941-794-5621
Practice Address - Fax:941-761-1532
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9106858363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical