MEDICARE: MR. THOMAS C DRAKE I 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
1	363A00000X	Physician Assistant	PA9100914	FL

General Provider Information

NPI Number	:	1588761431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS C DRAKE I PA-C

Provider Business Mailing Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-317-5069
Fax Number	:	904-778-6440

Provider Business Practice Location Address
First Line	:	5851 TIMUQUANA RD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7878
Country	:	US
Telephone Number	:	904-317-5069
Fax Number	:	904-778-6440

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/31/2011

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Directions to “ MR. THOMAS C DRAKE I PA-C” Practice Location

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