Provider Demographics
NPI:1417670951
Name:CARRAZANA, JASON DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:CARRAZANA
Suffix:
Gender:M
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 1:6007 LINNEAL BEACH DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1935
Mailing Address - Country:US
Mailing Address - Phone:407-920-8337
Mailing Address - Fax:
Practice Address - Street 1:2948 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3416
Practice Address - Country:US
Practice Address - Phone:407-788-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116442363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical