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NPI Code Detail

MEDICARE: JONATHAN THOMAS NUSBAUM PA-C

MEDICARE: JONATHAN THOMAS NUSBAUM PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA9113497FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255931325
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN THOMAS NUSBAUM PA-C
Provider Business Mailing Address
First Line : 200 N LAKEMONT AVE
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-3273
Country : US
Telephone Number : 407-303-7283
Fax Number : 407-303-0347
Provider Business Practice Location Address
First Line : 1700 S TAMIAMI TRL
Second Line :
City : SARASOTA
State : FL
Zip : 34239-3509
Country : US
Telephone Number : 941-917-4896
Fax Number : 941-917-6884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2020
Last Update Date : 02/10/2026

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