Provider Demographics
NPI:1316373343
Name:CALVARESE, JONATHAN P (PA-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:CALVARESE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:P
Other - Last Name:CALVARESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:7943 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5409
Mailing Address - Country:US
Mailing Address - Phone:251-633-0123
Mailing Address - Fax:
Practice Address - Street 1:7943 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5409
Practice Address - Country:US
Practice Address - Phone:251-633-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant