Provider Demographics
NPI:1104451319
Name:ARMSTRONG, LOGAN DAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:DAVIS
Last Name:ARMSTRONG
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 1:409 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-2107
Mailing Address - Country:US
Mailing Address - Phone:954-774-0677
Mailing Address - Fax:
Practice Address - Street 1:1234 SE MAGNOLIA EXT UNIT 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3770
Practice Address - Country:US
Practice Address - Phone:352-401-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant