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General NPI Number Information
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NPI Number | 1548263882
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Entity Type | Individual
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Provider Name | JASON KOTULA P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD S STE 415
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4299
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Country | US
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Telephone | 904-296-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 UNIVERSITY BLVD S STE 415
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4299
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Country | US
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Telephone | 904-296-2522
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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 | 001621
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 009808
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License Number State | NY
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