Healthcare Provider Details

I. General information

NPI: 1306757471
Provider Name (Legal Business Name): WILLIAM GARRETT WASKO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6206 ATLANTIC BLVD STE 1
JACKSONVILLE FL
32211-7560
US

IV. Provider business mailing address

6206 ATLANTIC BLVD STE 1
JACKSONVILLE FL
32211-7560
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-3131
  • Fax: 904-731-0209
Mailing address:
  • Phone: 904-731-3131
  • Fax: 904-731-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: