Provider Demographics
NPI:1265651772
Name:FALCONE, JONATHAN JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:FALCONE
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 1:1524 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3410
Mailing Address - Country:US
Mailing Address - Phone:386-235-0423
Mailing Address - Fax:386-673-2743
Practice Address - Street 1:279 S YONGE ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6257
Practice Address - Country:US
Practice Address - Phone:386-673-2133
Practice Address - Fax:386-673-2743
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9101282363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4587CMedicare ID - Type Unspecified
FLP13935Medicare UPIN