Provider Demographics
NPI:1376896167
Name:TORRES, JENNIFER LORRAINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:TORRES
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:20337 SW 54TH PL
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1575
Mailing Address - Country:US
Mailing Address - Phone:954-680-3191
Mailing Address - Fax:
Practice Address - Street 1:14661 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-5703
Practice Address - Country:US
Practice Address - Phone:786-467-5260
Practice Address - Fax:305-595-3088
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9106759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant