Provider Demographics
NPI:1316489859
Name:COLBORNE, KASEY MAXINE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:MAXINE
Last Name:COLBORNE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:836 PRUDENTIAL DR STE 1001
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8337
Practice Address - Country:US
Practice Address - Phone:904-398-0033
Practice Address - Fax:904-398-6774
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-12-22
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9109936363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPAT9109936OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH