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NPI Code Detail

MEDICARE: JESSE QUINN OWENS BADGER PA-C

MEDICARE: JESSE QUINN OWENS BADGER 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 AssistantPA9102404FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA9102404OTHERFLPHYSICIAN ASSISTANT LIC.

General Provider Information

NPI Number : 1902027717
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE QUINN OWENS BADGER PA-C
Provider Business Mailing Address
First Line : 8823 SAN JOSE BLVD STE 209
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-4288
Country : US
Telephone Number : 904-404-7044
Fax Number : 904-329-2303
Provider Business Practice Location Address
First Line : 8823 SAN JOSE BLVD STE 209
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-4288
Country : US
Telephone Number : 904-404-7044
Fax Number : 904-329-2303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 01/19/2020

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Directions to “ JESSE QUINN OWENS BADGER PA-C” Practice Location

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