Provider Demographics
NPI:1407687502
Name:KLINE, JADEN CASSIDY
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:CASSIDY
Last Name:KLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 NW GREENBANK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3039
Mailing Address - Country:US
Mailing Address - Phone:407-201-1955
Mailing Address - Fax:
Practice Address - Street 1:3450 11TH CT STE 204
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-770-6850
Practice Address - Fax:772-770-6851
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant