Provider Demographics
NPI:1720241763
Name:JOHN-FINN, THEOPHILUS (PA-C)
Entity type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:
Last Name:JOHN-FINN
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 1:1300 BOB CAT CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3852
Mailing Address - Country:US
Mailing Address - Phone:407-629-1599
Mailing Address - Fax:321-397-6002
Practice Address - Street 1:5201 RAYMOND STREET
Practice Address - Street 2:ORLANDO VA MEDICAL CENTER
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:321-397-6002
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical