Provider Demographics
NPI:1811769029
Name:WADE, ERIN OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:OLIVIA
Last Name:WADE
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-0615
Mailing Address - Fax:855-975-0615
Practice Address - Street 1:4727 SUNBEAM RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6188
Practice Address - Country:US
Practice Address - Phone:904-512-1899
Practice Address - Fax:904-770-7592
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant