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NPI Code Detail

MEDICARE: BONNIE JEAN GANDEE PA-C

MEDICARE: BONNIE JEAN GANDEE 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
1363AM0700XMedical Physician AssistantPA9101664FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01086308OTHERFLRAILROAD MEDICARE

General Provider Information

NPI Number : 1851318828
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE JEAN GANDEE PA-C
Provider Business Mailing Address
First Line : PO BOX 43667
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32203-3667
Country : US
Telephone Number : 904-720-0599
Fax Number : 904-376-4036
Provider Business Practice Location Address
First Line : 14534 OLD SAINT AUGUSTINE RD STE 3420
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-2616
Country : US
Telephone Number : 904-493-8001
Fax Number : 904-338-0852
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 03/31/2020

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Directions to “ BONNIE JEAN GANDEE PA-C” Practice Location

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