Provider Demographics
NPI:1659927390
Name:JENSEN, MADELINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:JENSEN
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 1:1816 SALK AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4300
Mailing Address - Country:US
Mailing Address - Phone:352-343-2461
Mailing Address - Fax:352-343-5968
Practice Address - Street 1:1816 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4300
Practice Address - Country:US
Practice Address - Phone:352-343-2461
Practice Address - Fax:352-343-5968
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant