Provider Demographics
NPI:1063804722
Name:ASPINWALL, JONATHAN (ARNP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ASPINWALL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 OAKRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-8168
Mailing Address - Country:US
Mailing Address - Phone:850-682-7212
Mailing Address - Fax:850-682-6302
Practice Address - Street 1:369 N MAIN ST
Practice Address - Street 2:UITE A
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3541
Practice Address - Country:US
Practice Address - Phone:850-398-6963
Practice Address - Fax:850-398-8277
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9294295363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIE052ZMedicare PIN