Provider Demographics
NPI:1063183465
Name:CONSTANTINIDES, PETER (PA-C)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:CONSTANTINIDES
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S, STE 135
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4231
Mailing Address - Country:US
Mailing Address - Phone:904-398-8147
Mailing Address - Fax:904-400-6674
Practice Address - Street 1:3627 UNIVERSITY BLVD S, STE 135
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4231
Practice Address - Country:US
Practice Address - Phone:904-398-8147
Practice Address - Fax:904-400-6674
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant