Provider Demographics
NPI:1053322461
Name:JONES, CHARLES WESLEY (PA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WESLEY
Last Name:JONES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 S CHICKASAW TRL STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3558
Mailing Address - Country:US
Mailing Address - Phone:407-303-6588
Mailing Address - Fax:407-303-6592
Practice Address - Street 1:258 S CHICKASAW TRL STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3558
Practice Address - Country:US
Practice Address - Phone:407-303-6588
Practice Address - Fax:407-303-6592
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106981363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM432YOtherMEDICARE
FL101659300Medicaid