Provider Demographics
NPI:1285019562
Name:COHN, JANE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:COHN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:COHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:102 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2262
Mailing Address - Country:US
Mailing Address - Phone:215-527-5094
Mailing Address - Fax:
Practice Address - Street 1:102 AVALON DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2262
Practice Address - Country:US
Practice Address - Phone:215-527-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108830207QA0401X, 363AM0700X
FL12850195622084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine