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General NPI Number Information
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NPI Number | 1336650167
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Entity Type | Individual
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Provider Name | GINA PATEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 2377 DUNN AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6983
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Country | US
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Telephone | 904-633-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 12900 BROXTON BAY DR APT 1427
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8528
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9110498
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License Number State | FL
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