Provider Demographics
NPI:1013272244
Name:PICHARDO, JANNEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JANNEL
Middle Name:
Last Name:PICHARDO
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 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-273-7998
Mailing Address - Fax:305-273-7275
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE A-100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-273-7998
Practice Address - Fax:305-273-7275
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9105636OtherFLORIDA STATE LICENCE NUMBER
FLPAX00008507OtherPRESCRIBING LICENSE NUMBER