Active NPI
Jessica Susana Chavarria
- Physician Assistant
- Fort Lauderdale, FL
National Provider Identifier
1073167896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9111858
- Practice address
- 1301 E Broward Blvd Ste 240
Fort Lauderdale, FL 33301-2111 - Phone
- (954) 983-1211
- NPI assigned
- Jul 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9111858 | FL | Primary |
Addresses
Primary practice location
1301 E Broward Blvd Ste 240
Fort Lauderdale, FL 33301-2111
Mailing address
10068 SW 117TH CT
Miami, FL 33186-8521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9111858 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592524800000",
"number": "1073167896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10068 SW 117TH CT",
"city": "MIAMI",
"state": "FL",
"postal_code": "331868521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 E BROWARD BLVD STE 240",
"city": "FORT LAUDERDALE",
"state": "FL",
"postal_code": "333012111",
"telephone_number": "954-983-1211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVARRIA",
"first_name": "JESSICA",
"middle_name": "SUSANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-30",
"last_updated": "2020-06-19",
"certification_date": "2020-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9111858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Lauderdale, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.