Active NPI
Jelena Petkovic, PA
- Physician Assistant
- Miami, FL
National Provider Identifier
1801916127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9103145
- Practice address
- 1441 Brickell Ave
Suite 300
Miami, FL 33131-3425 - Phone
- (305) 624-0009
- Fax
- (305) 373-1175
- NPI assigned
- Mar 30, 2007
- 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 | PA9103145 | FL | Primary |
Addresses
Primary practice location
1441 Brickell Ave
Suite 300
Miami, FL 33131-3425
Mailing address
1900 Sunset Harbor Dr
# 1115
Miami Beach, FL 33139
Phone (305) 624-0009
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9103145 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801916127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 SUNSET HARBOR DR",
"address_2": "# 1115",
"city": "MIAMI BEACH",
"state": "FL",
"postal_code": "33139",
"telephone_number": "305-624-0009",
"fax_number": "305-373-1175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1441 BRICKELL AVE",
"address_2": "SUITE 300",
"city": "MIAMI",
"state": "FL",
"postal_code": "331313425",
"telephone_number": "305-624-0009",
"fax_number": "305-373-1175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETKOVIC",
"first_name": "JELENA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9103145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.