Provider Demographics
NPI:1598927071
Name:SMOOK, JASON DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:SMOOK
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 1:483 N SEMORAN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-680-2273
Mailing Address - Fax:321-274-0224
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-680-2273
Practice Address - Fax:321-274-0224
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1094363A00000X
FLPA9107856363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012418200Medicaid
FL012418200Medicaid