Provider Demographics
NPI:1285601559
Name:FILS, RODNEY ANTOINE (PA-C)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:ANTOINE
Last Name:FILS
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:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:761 EDGEWOOD AVE N
Practice Address - Street 2:COMMONWEALTH FAMILY PRACTICE CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-3013
Practice Address - Country:US
Practice Address - Phone:904-389-2251
Practice Address - Fax:904-384-4663
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102272363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2914514-00Medicaid
GA100002811BMedicaid
FLE8900Medicare PIN
FL970029620Medicare PIN
FL2914514-00Medicaid
FLE8900ZMedicare PIN
FLP77962Medicare UPIN