Provider Demographics
NPI:1316271794
Name:STRENNEN, MARY ELISA (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELISA
Last Name:STRENNEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELISA
Other - Last Name:MEMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CST
Mailing Address - Street 1:6550 N FEDERAL HWY
Mailing Address - Street 2:SUITE 512
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1404
Mailing Address - Country:US
Mailing Address - Phone:954-267-9777
Mailing Address - Fax:954-772-7801
Practice Address - Street 1:6550 N FEDERAL HWY
Practice Address - Street 2:SUITE 512
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1404
Practice Address - Country:US
Practice Address - Phone:954-267-9777
Practice Address - Fax:954-772-7801
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105214363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical