Healthcare Provider Details

I. General information

NPI: 1700817970
Provider Name (Legal Business Name): GINA L MCDOWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA L WILQUET PA-C BC-ADM

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ASH DRIVE
EGLIN AFB FL
32542
US

IV. Provider business mailing address

1 ASH DRIVE
EGLIN AFB FL
32542
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-9484
  • Fax: 850-883-7999
Mailing address:
  • Phone: 850-883-9484
  • Fax: 850-883-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC50000191
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: