Provider Demographics
NPI:1619305067
Name:JENNIFER SASSI PA
Entity Type:Organization
Organization Name:JENNIFER SASSI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:239-691-4076
Mailing Address - Street 1:22150 RED LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2975
Mailing Address - Country:US
Mailing Address - Phone:239-691-4076
Mailing Address - Fax:239-992-1107
Practice Address - Street 1:3700 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7649
Practice Address - Country:US
Practice Address - Phone:239-939-5233
Practice Address - Fax:239-939-9225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER SASSI PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3416952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3683OtherBCBS
FL3066932000OtherMEDICAID
FLU4206ZMedicare PIN