Basic Information
| Provider Information | |||||||||
| NPI: | 1417670951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRAZANA | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6007 LINNEAL BEACH DR | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327031935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079208337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2948 W LAKE MARY BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327463416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077882000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2022 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 9116442 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.