Wagner, Jason Fredrick

Wagner, Jason Fredrick is an sole proprietor health care provider with primary practice located at 111 W Coral Way , Hollywood FL 33021-3860. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is his primary health care specialty. Wagner, Jason Fredrick can be contacted via phone (954) 964-6338.

Contact Information

Primary practice address
111 W Coral Way Hollywood FL 33021-3860
Phone: (954) 964-6338
Fax: (954) 965-1327
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X MH8961 Florida
Behavioral Health & Social Service Providers / Mental Health 101YM0800X MH8961 Florida
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X APRN11004343 Florida

Profile Details

NPI number 1720536691
LBN Legal business name Wagner, Jason Fredrick
Credentials APRN, LMHC, MCAP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 20th, 2016
Last updated May 1st, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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