Provider Demographics
NPI:1104419910
Name:NEMERSON, JERRED (PA-C)
Entity type:Individual
Prefix:
First Name:JERRED
Middle Name:
Last Name:NEMERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 W SAMPLE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3173
Mailing Address - Country:US
Mailing Address - Phone:561-322-3588
Mailing Address - Fax:754-812-5993
Practice Address - Street 1:6280 W SAMPLE RD STE 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3173
Practice Address - Country:US
Practice Address - Phone:561-322-3588
Practice Address - Fax:754-812-5993
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant