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MRS. JENNIFER MARY BRODERICK PA-C
NPI 1962499723
Physician Assistant - Surgical in St Petersburg, FL

Active since October 05, 2005
960 7TH AVE N, ST PETERSBURG, FL 33705(727) 821-8101(727) 894-8360 Get Directions Write a Review

NPPES record last updated: March 29, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Jennifer Mary Broderick Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. JENNIFER MARY BRODERICK PA-C (NPI 1962499723) is an individual surgical provider in St Petersburg, Florida, licensed in Florida (9102539) and active in the NPI registry since October 2005.

NPPES Registry Identity

NPI1962499723
Entity TypeIndividualFemale
Primary Taxonomy363AS0400X
Provider Legal NameMRS. JENNIFER MARY BRODERICKCredential: PA-C
Location Address960 7TH AVE NSt Petersburg, FL 33705-1347
Mailing Address960 7th Ave NSt Petersburg, FL 33705-1347 · (727) 821-8101 · Fax (727) 894-8360
Phone(727) 821-8101
Fax(727) 894-8360
Sole ProprietorNo
Enumeration DateOctober 5, 2005
Last NPPES UpdateMarch 29, 2013
✔ NPI 1962499723 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
License✔ Licensed in FL · 9102539
960 7TH AVE N, St Petersburg, FL 33705
Open in Google Maps ↗

Other Names 1

Former Name (1)Miss Jennifer Mary Moon Pa-c

Other Identifiers 3

Medicare PINU1343AFL
Medicaid291647900FL
Medicare UPINP98242FL

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHUN KEVIN YANG MD
Surgery (Vascular Surgery)
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (277) 821-8101
GREATER FLORIDA ANESTHESIOLOGISTS, LLC
Anesthesiology (Pain Medicine)
960 7TH AVE N
SAINT PETERSBURG, FL 33705
Pinellas County (877) 328-1119
MARISOL SCHULTHEIS PA-C
Physician Assistant (Surgical)
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (727) 821-8101
EVA I SCHOFIELD PA-C
Physician Assistant (Surgical)
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (727) 821-8101
TRACY A MORNINGSTAR PA-C
Physician Assistant (Surgical)
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (727) 821-8101
BAY SURGICAL SPECIALISTS, LLC
Surgery (Vascular Surgery)
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (727) 821-8101
ANESTHESIA DYNAMICS LLC
Anesthesiology
960 7TH AVE N
SAINT PETERSBURG, FL 33705
Pinellas County (240) 469-2181
DREW THOMAS OBERMEIER PA-C
Physician Assistant
960 7TH AVE N
ST PETERSBURG, FL 33705
Pinellas County (727) 821-8101

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jennifer Broderick's NPI number?

The NPI number for Jennifer Broderick is 1962499723. It was assigned to this individual provider in the NPPES registry on October 5, 2005. The provider is also known as Miss Jennifer Mary Moon Pa-C.

Where is Jennifer Broderick located?

Jennifer Broderick practices at 960 7th Ave N, St Petersburg, FL 33705. The listed phone number is (727) 821-8101.

What is Jennifer Broderick's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

When was this NPI record last updated?

The NPPES record for Jennifer Broderick was last updated on March 29, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.