MRS. JENNIFER MARY BRODERICK (NPI# 1962499723) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962499723 |
| Entity Type | Individual |
| Full Name | MRS. JENNIFER MARY BRODERICK |
| Other Name | MISS JENNIFER MARY MOON |
| Credential | PA-C |
| Practice Address |
960 7th Ave N St Petersburg FL 33705-1347 |
| Practice Telephone | 7278218101 |
| Practice Fax Number | 7278948360 |
| Mailing Telephone | 7278218101 |
| Mailing Fax Number | 7278948360 |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2013-03-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
9102539 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 291647900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003185372 | Jennifer A Broderick | Psychologist | 12938 Ablingdon Dr, Frisco, TX 75035 | 2011-12-15 |
| 1861860728 | Jennifer Broderick | Physical Therapy Assistant | 3703 W Lake Ave Ste 200, Glenview, IL 60026-1266 | 2015-09-09 |
| 1144258807 | Jennifer L Broderick | Contractor | 79 W Main St, Lexington, OH 44904-1113 | 2006-06-29 |
| Street Address |
960 7TH AVE N |
| City | ST PETERSBURG |
| State | FL |
| Zip Code | 33705-1347 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417504077 | Brittany Nicole Pettenger | Physician Assistant | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2019-08-19 |
| 1811477631 | Drew Thomas Obermeier | Physician Assistant | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2018-08-21 |
| 1437609112 | Tracy Ann Morningstar | Physician Assistant | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2016-10-06 |
| 1922472919 | Stephanie Giparas | Physician Assistant | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2015-11-14 |
| 1245649847 | Marisol Schultheis | Physician Assistant | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2014-08-07 |
| 1083904593 | Chun Kevin Yang | Surgery | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2011-04-18 |
| 1871810655 | Benjamin Edward Szpila | Surgery | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2010-05-03 |
| 1881898377 | Jamii St. Julien | Surgery | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2007-06-11 |
| 1336123207 | Kevin Lee Huguet | Surgery | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2005-12-02 |
| 1962499715 | Paul Steven Collins | Surgery | 960 7th Ave N, St Petersburg, FL 33705-1347 | 2005-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154935781 | Caressa Alice Slocum | Psychologist | 840 Dr M.l.k. Jr St N, St. Petersburg, FL 33705 | 2020-09-01 |
| 1386133015 | Angela Ann Little | Social Worker | 920 Country Club Way S, St Petersburg, FL 33705 | 2018-05-08 |
| 1497279483 | Infinity Health Consultants, LLC. | In Home Supportive Care | 1001 27th Avenue South, St. Petersburg, FL 33705 | 2017-08-01 |
| 1801320528 | Dedicated Senior Medical Center St. Petersburg, LLC. | Non-Pharmacy Dispensing Site | 901 22nd Avenue South, Dedicated Senior Medical Center St. Petersburg, LLC., St. Petersburg, FL 33705 | 2017-04-19 |
| 1790135762 | Robin Dong | Emergency Medicine | 1095 5th Ave N, St. Petersburg, FL 33705 | 2016-06-20 |
| 1437550084 | Community Health Center of Pinellas Inc | Clinic/Center | 612 Dr Martin L King St N, St Petersburg, FL 33705 | 2014-09-12 |
| 1164851754 | Jennifer Carey | Counselor | 11 Mlk Jr St South, St. Petersburg, FL 33705 | 2013-11-05 |
| 1750623997 | Dannaly Reyes Baerga | Physical Medicine & Rehabilitation | 1201 5th Ave N Ste 202, St Petersburg, FL 33705 | 2013-03-26 |
| 1518209055 | Nii Sai Torto | Emergency Medicine | 500 Doctor. M.l.k, Jr. Street North, Ste 303, Saint Petersburg, FL 33705 | 2013-03-22 |
| 1790034635 | Melissa White Kidwell | Physical Therapist | 500 Mlking Street N, Ste 100, St. Petersburg, FL 33705 | 2012-09-06 |
| Find all providers in zip 33705 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972168052 | Carlee Freed | Physician Assistant | 2191 9th Ave N Ste 270, St Petersburg, FL 33713-7149 | 2019-05-05 |
| 1558633602 | Jennifer Michelle Boyd | Physician Assistant | 636 16th Ave Ne, St Petersburg, FL 33704-4719 | 2012-02-06 |
| 1457511685 | Sheila Faye Zimmardi | Physician Assistant | 625 6th Ave S Ste 450, St Petersburg, FL 33701-4629 | 2008-06-11 |
| 1215987029 | Claudia B Botero | Physician Assistant | 239 2nd Ave S, Suite 200, St Petersburg, FL 33701-4333 | 2006-05-11 |
| 1700875960 | Angela Bowersock | Physician Assistant | 601 7th St S Ste 205, St Petersburg, FL 33701-4708 | 2005-10-19 |
| 1174177927 | Us Medical Solutions, LLC | Physician Assistant | 871 Ibis Walk Pl N Unit 3204, St Petersburg, FL 33716-3857 | 2019-07-30 |
| 1184282907 | Mark Daicoff | Physician Assistant | 4600 4th St N, St Petersburg, FL 33703-3802 | 2019-06-05 |
| 1760045272 | Savannah Kelly Poor | Physician Assistant | 625 6th Ave S Ste 450, St Petersburg, FL 33701-4629 | 2019-04-19 |
| 1588138499 | Chandler Melton | Physician Assistant | 625 6th Ave S Ste 450, St Petersburg, FL 33701-4629 | 2019-01-14 |
| 1699240549 | Hilary Margaret Kupstas | Physician Assistant | 625 6th Ave S Ste 450, St Petersburg, FL 33701-4629 | 2018-10-08 |
| Find all providers in ST PETERSBURG | ||||
| City | ST PETERSBURG |
| Zip Code | 33705 |
Please comment or provide details below to improve the information on MRS. JENNIFER MARY BRODERICK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.