Provider Demographics
NPI:1407335508
Name:GART, JORDAN PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAIGE
Last Name:GART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SW 7TH ST APT 3202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2982
Mailing Address - Country:US
Mailing Address - Phone:954-540-6154
Mailing Address - Fax:
Practice Address - Street 1:10454 NW 31ST TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1200
Practice Address - Country:US
Practice Address - Phone:305-330-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110910363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant