Provider Demographics
NPI:1083951214
Name:JABLONSKI, AMY MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:JABLONSKI
Suffix:
Gender:F
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 1:1010 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5924
Mailing Address - Country:US
Mailing Address - Phone:239-443-0705
Mailing Address - Fax:
Practice Address - Street 1:1010 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5924
Practice Address - Country:US
Practice Address - Phone:239-443-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101983363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant