Provider Demographics
NPI:1932416120
Name:WOLF, JASON R (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:WOLF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:8000 STATE ROAD 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-7703
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:8000 STATE ROAD 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-7703
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-761-0712
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2025-07-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0449980001Medicare NSC
IN0449980009Medicare NSC
INM400037555Medicare PIN