Provider Demographics
NPI:1801135561
Name:WHITE, JACQUELYN LEE (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5850 CORAL RIDGE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3378
Mailing Address - Country:US
Mailing Address - Phone:954-714-8200
Mailing Address - Fax:954-840-2626
Practice Address - Street 1:5850 CORAL RIDGE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3378
Practice Address - Country:US
Practice Address - Phone:954-714-8200
Practice Address - Fax:954-840-2626
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical