NPIMap

Organization Active NPI

Professional Surgical Assistants

  • Surgical Physician Assistant
  • Plantation, FL
National Provider Identifier
1740618974
Registry record updated Oct 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA9107526 Issued in FL
Legal business name
PROFESSIONAL SURGICAL ASSISTANTS
Practice address
300 S Pine Island Rd
105
Plantation, FL 33324-2673
Phone
(954) 382-2930
NPI assigned
Oct 25, 2013
Last updated
Oct 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacki M Renta
Title
Credentialing
Phone
(954) 382-2930

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X PA9107526 FL Primary

Addresses

Primary practice location

300 S Pine Island Rd
105
Plantation, FL 33324-2673

Mailing address

10190 SW 3Rd St
Plantation, FL 33324-2234
Phone (954) 382-2930

National Provider Directory

National Provider Directory
Tax ID family
Carol Rowe Crnfa PA4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

300 S Pine Island Rd
Ste 105
Plantation, FL 33324
Phone (954) 382-2930

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382659200000",
    "number": "1740618974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10190 SW 3RD ST",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242234",
            "telephone_number": "954-382-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S PINE ISLAND RD",
            "address_2": "105",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333242673",
            "telephone_number": "954-382-2930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL SURGICAL ASSISTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2013-10-25",
        "status": "A",
        "authorized_official_last_name": "RENTA",
        "authorized_official_first_name": "JACKI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "954-382-2930"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plantation, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.