Provider Demographics
NPI:1760887210
Name:SWANSON, MICHAEL JARETH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JARETH
Last Name:SWANSON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2402 FRIST BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-462-3939
Mailing Address - Fax:772-462-3938
Practice Address - Street 1:2402 FRIST BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-462-3939
Practice Address - Fax:772-462-3938
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2015-04-13
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108363363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical