Provider Demographics
NPI:1831436658
Name:JAEGER, SUZANNE (PA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JAEGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19101 MYSTIC POINTE DR
Mailing Address - Street 2:#2309
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4512
Mailing Address - Country:US
Mailing Address - Phone:954-296-7061
Mailing Address - Fax:
Practice Address - Street 1:3006 JOSIE BILLIE AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2918
Practice Address - Country:US
Practice Address - Phone:954-962-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9101127363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical