Healthcare Provider Details

I. General information

NPI: 1760427355
Provider Name (Legal Business Name): JOSEPH F CUPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH FORT CUPP

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 06/06/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD SUITE 14
GAINESVILLE FL
32607-2826
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4592
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-4321
  • Fax: 352-373-0613
Mailing address:
  • Phone: 352-416-1082
  • Fax: 325-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: