Provider Demographics
NPI:1245202167
Name:MABE, CHERISSE RAGASA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHERISSE
Middle Name:RAGASA
Last Name:MABE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP EMERGENCY MEDICINE
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-6340
Practice Address - Fax:904-244-4508
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-09-17
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2921014-00Medicaid
GA436407997BMedicaid
GA436047997AMedicaid
FLP00230368Medicare PIN
GA436047997AMedicaid
FL2921014-00Medicaid