Provider Demographics
NPI:1225094154
Name:JACKSON, PATRICIA MCGARVEY (PA)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MCGARVEY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6257
Mailing Address - Country:US
Mailing Address - Phone:904-725-6300
Mailing Address - Fax:904-725-5447
Practice Address - Street 1:6800 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6257
Practice Address - Country:US
Practice Address - Phone:904-725-6300
Practice Address - Fax:904-725-5447
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S90423Medicare UPIN
FLE3150ZMedicare PIN