Provider Demographics
NPI:1083278782
Name:JEAN, WILLIAMSON (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAMSON
Middle Name:
Last Name:JEAN
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 1:101 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4201
Mailing Address - Country:US
Mailing Address - Phone:863-858-8000
Mailing Address - Fax:
Practice Address - Street 1:101 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4201
Practice Address - Country:US
Practice Address - Phone:863-858-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113379363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical