Provider Demographics
NPI:1659750909
Name:BLACKMER, JASON D (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:BLACKMER
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 1:4863 PALM COAST PKWY NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3665
Mailing Address - Country:US
Mailing Address - Phone:386-222-7746
Mailing Address - Fax:386-310-2381
Practice Address - Street 1:4863 PALM COAST PKWY NW UNIT 2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3665
Practice Address - Country:US
Practice Address - Phone:386-222-7746
Practice Address - Fax:386-310-2381
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108663363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical