Healthcare Provider Details

I. General information

NPI: 1245830314
Provider Name (Legal Business Name): JONATHAN V KORAH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 1100
JACKSONVILLE FL
32216-5876
US

IV. Provider business mailing address

2 SHIRCLIFF WAY STE 300
JACKSONVILLE FL
32204-4765
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3103
  • Fax: 904-296-3106
Mailing address:
  • Phone: 904-308-7959
  • Fax: 904-308-7938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: