Provider Demographics
NPI:1669458519
Name:MAZZA, JASON S (OA-C, CSA, SA-C, OTC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:S
Last Name:MAZZA
Suffix:
Gender:M
Credentials:OA-C, CSA, SA-C, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 TECOMA DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5049
Mailing Address - Country:US
Mailing Address - Phone:727-372-3918
Mailing Address - Fax:727-372-3918
Practice Address - Street 1:1745 CITRON CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4902
Practice Address - Country:US
Practice Address - Phone:727-372-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant