Provider Demographics
NPI:1063416550
Name:ALLEN, JOSEPH DAVID (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:ALLEN
Suffix:
Gender:M
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 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-265-6478
Mailing Address - Fax:904-265-6409
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:SUITE 801
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8334
Practice Address - Country:US
Practice Address - Phone:904-288-0433
Practice Address - Fax:904-288-8996
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290895600Medicaid
FL290895600Medicaid
FLP15004Medicare UPIN