Active NPI
Wagner Jean Mary, PA
- Physician Assistant
- Orlando, FL
National Provider Identifier
1811809023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001187-P.A.
- Practice address
- 48 N Kirkman Rd Ste 6
Orlando, FL 32811-1466 - Phone
- (954) 673-9512
- NPI assigned
- Sep 22, 2026
- Last updated
- Sep 22, 2026
- Sex
- Male
- Sole proprietor
- Yes
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 | 001187-P.A. | PR | Primary |
Addresses
Primary practice location
48 N Kirkman Rd Ste 6
Orlando, FL 32811-1466
Mailing address
17545 Bella Nova Dr
Orlando, FL 32820-1446
Phone (954) 673-9512
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790035200000",
"number": "1811809023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17545 BELLA NOVA DR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328201446",
"telephone_number": "954-673-9512"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "48 N KIRKMAN RD STE 6",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328111466",
"telephone_number": "954-673-9512"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEAN MARY",
"first_name": "WAGNER",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-09-22",
"last_updated": "2026-09-22",
"certification_date": "2026-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "PR",
"license": "001187-P.A.",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.