Healthcare Provider Details

I. General information

NPI: 1396037370
Provider Name (Legal Business Name): NATHAN KENT ADAMS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE OAKS DR
SAINT JOHNS FL
32259-3876
US

IV. Provider business mailing address

201 VILLAGE OAKS DR
SAINT JOHNS FL
32259-3876
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0442
  • Fax: 904-240-0471
Mailing address:
  • Phone: 904-240-0442
  • Fax: 904-240-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006082
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9105996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: