Provider Demographics
NPI:1396037370
Name:ADAMS, NATHAN KENT (PA-C)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:KENT
Last Name:ADAMS
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 1:115 BARTRAM OAKS WALK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3243
Mailing Address - Country:US
Mailing Address - Phone:904-240-0442
Mailing Address - Fax:904-240-0471
Practice Address - Street 1:115 BARTRAM OAKS WALK
Practice Address - Street 2:SUITE 104
Practice Address - City:ST. JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3243
Practice Address - Country:US
Practice Address - Phone:904-240-0442
Practice Address - Fax:904-240-0471
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006082363A00000X
FLPA9105996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant