Provider Demographics
NPI:1144773052
Name:STILES, JOEL (PA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:STILES
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 1:3627 UNIVERSITY BLVD S STE 415
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4299
Mailing Address - Country:US
Mailing Address - Phone:904-296-2522
Mailing Address - Fax:
Practice Address - Street 1:3627 UNIVERSITY BLVD S STE 415
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4299
Practice Address - Country:US
Practice Address - Phone:904-296-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2574363A00000X
FLPA9115372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2728PAMedicaid
SC2728PAMedicaid
SCSC91745019Medicare PIN