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NPI Code Detail

MEDICARE: HEATHER PUTNAM PAC

MEDICARE: HEATHER PUTNAM PAC
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
1363AS0400XSurgical Physician AssistantPA9106882FL

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 : 1730432170
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER PUTNAM PAC
Provider Business Mailing Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4500 SAN PABLO RD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-1865
Country : US
Telephone Number : 904-953-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2012
Last Update Date : 03/24/2026

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1679253215 — DANELIA YAOSKA MARTINEZ NARVAEZ DNP
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1477940203 — PHILIP TIPTON MD
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Directions to “ HEATHER PUTNAM PAC” Practice Location

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