Provider Demographics
NPI:1346028701
Name:EDGIL, JUSTIN MARK (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MARK
Last Name:EDGIL
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2939
Mailing Address - Country:US
Mailing Address - Phone:386-804-9812
Mailing Address - Fax:
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6500
Practice Address - Country:US
Practice Address - Phone:352-401-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant