Provider Demographics
NPI:1548200769
Name:NORMAN, JENNIFER LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1990 MAIN ST STE 700
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5955
Mailing Address - Country:US
Mailing Address - Phone:941-867-3376
Mailing Address - Fax:941-667-5544
Practice Address - Street 1:1990 MAIN ST STE 700
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5955
Practice Address - Country:US
Practice Address - Phone:941-867-3376
Practice Address - Fax:941-667-5544
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102427363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8295YMedicare UPIN