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NPI Code Detail

MEDICARE: JASON DANIEL FAGAN PA-C

MEDICARE: JASON DANIEL FAGAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9113844FL

General Provider Information

NPI Number : 1538418934
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON DANIEL FAGAN PA-C
Provider Business Mailing Address
First Line : 1693 LEE RD STE B
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-2260
Country : US
Telephone Number : 407-499-5010
Fax Number :
Provider Business Practice Location Address
First Line : 1693 LEE RD STE B
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-2260
Country : US
Telephone Number : 407-499-5010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2012
Last Update Date : 02/17/2026

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Directions to “ JASON DANIEL FAGAN PA-C” Practice Location

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