Healthcare Provider Details

I. General information

NPI: 1487039178
Provider Name (Legal Business Name): JAMES ROBERT OSBORNE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

IV. Provider business mailing address

450 OLDFIELD DR
FLEMING ISLAND FL
32003-7892
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-8435
  • Fax:
Mailing address:
  • Phone: 904-703-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: