Provider Demographics
NPI:1275557217
Name:MORIARTY LOEVEN, JENNIFER SUSAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:MORIARTY LOEVEN
Suffix:
Gender:F
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 1:232 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1932
Mailing Address - Country:US
Mailing Address - Phone:941-254-4957
Mailing Address - Fax:
Practice Address - Street 1:232 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1932
Practice Address - Country:US
Practice Address - Phone:941-254-4957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0584363AM0700X
FLPA9117211363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical