Provider Demographics
NPI:1215053665
Name:EDWARDS, JEFFREY A (PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 DUNN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6359
Mailing Address - Country:US
Mailing Address - Phone:904-757-5656
Mailing Address - Fax:904-757-5650
Practice Address - Street 1:1036 DUNN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6359
Practice Address - Country:US
Practice Address - Phone:904-757-5656
Practice Address - Fax:904-757-5650
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant