Provider Demographics
NPI:1487232625
Name:BRESLIN, JAMIE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:BRESLIN
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 1:2980 NE 207TH ST
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1457
Mailing Address - Country:US
Mailing Address - Phone:954-272-8330
Mailing Address - Fax:
Practice Address - Street 1:2980 NE 207TH ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1457
Practice Address - Country:US
Practice Address - Phone:954-272-8330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant