Provider Demographics
NPI:1427719285
Name:GEORGE, GEENA ANN
Entity type:Individual
Prefix:
First Name:GEENA
Middle Name:ANN
Last Name:GEORGE
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 1:201 NW 82ND AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1856
Mailing Address - Country:US
Mailing Address - Phone:954-368-8519
Mailing Address - Fax:
Practice Address - Street 1:201 NW 82ND AVE STE 404
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1856
Practice Address - Country:US
Practice Address - Phone:954-368-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant