Healthcare Provider Details

I. General information

NPI: 1649221615
Provider Name (Legal Business Name): JOSHUA B MASSEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/28/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PLANTATION ISLAND DR S STE 220
ST AUGUSTINE FL
32080-5174
US

IV. Provider business mailing address

5191 FIRST COAST TECH PKWY 3RD FLOOR
JACKSONVILLE FL
32224-0609
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-3321
  • Fax: 904-223-2169
Mailing address:
  • Phone: 904-223-3321
  • Fax: 904-223-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: