Provider Demographics
NPI:1891000972
Name:STROHFUS, JACKIE (PA)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:STROHFUS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 E MELBOURNE AVE
Mailing Address - Street 2:104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5970
Mailing Address - Country:US
Mailing Address - Phone:321-951-7404
Mailing Address - Fax:321-723-8527
Practice Address - Street 1:20 E MELBOURNE AVE
Practice Address - Street 2:104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5970
Practice Address - Country:US
Practice Address - Phone:321-951-7404
Practice Address - Fax:321-723-8527
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2932363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical