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General NPI Number Information
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NPI Number | 1487039178
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Entity Type | Individual
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Provider Name | JAMES ROBERT OSBORNE PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-8435
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Fax |
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Provider Business Mailing Address
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Address Line | 450 OLDFIELD DR
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-7892
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Country | US
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Telephone | 904-703-9079
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9108777
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License Number State | FL
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