Provider Demographics
NPI:1407925126
Name:YORK, JACQUELINE G (PA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:G
Last Name:YORK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30532
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1532
Mailing Address - Country:US
Mailing Address - Phone:850-916-3700
Mailing Address - Fax:850-916-3710
Practice Address - Street 1:1040 GULF BREEZE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-7809
Practice Address - Country:US
Practice Address - Phone:850-916-3700
Practice Address - Fax:850-916-3710
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59197952OtherBCBS ALABAMA - DH2
AL121498Medicaid
AL59197954OtherBCBS - SX
FLP00222818OtherMEDICARE RAILROAD
FLE2224ZOtherBCBS FLORIDA
FL290827100Medicaid
AL59010138OtherBCBS ALABAMA
AL121495Medicaid
FLY00MROtherBLUE CROSS BLUE SHIELD
AL593-05287OtherBCBS ALABAMA
AL593-05288OtherBCBS OF ALABAMA
AL59197954OtherBCBS - SX
AL121498Medicaid
AL59197952OtherBCBS ALABAMA - DH2
FLS75256Medicare UPIN
AL121495Medicaid