Provider Demographics
NPI:1447770821
Name:OPPENHEIMER, JAMIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:OPPENHEIMER
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 1:4515 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2937
Mailing Address - Country:US
Mailing Address - Phone:786-897-3831
Mailing Address - Fax:
Practice Address - Street 1:4515 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2937
Practice Address - Country:US
Practice Address - Phone:786-897-3831
Practice Address - Fax:786-897-3831
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant