Provider Demographics
NPI:1427386143
Name:PAREDES, MARIA ALEJANDRA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALEJANDRA
Last Name:PAREDES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ALEJANDRA
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1201 MONUMENT ROAD
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7428
Mailing Address - Country:US
Mailing Address - Phone:904-727-5151
Mailing Address - Fax:904-727-3887
Practice Address - Street 1:1201 MONUMENT ROAD
Practice Address - Street 2:SUITE 201B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7428
Practice Address - Country:US
Practice Address - Phone:904-727-5151
Practice Address - Fax:904-727-3887
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0016180-00Medicaid
FLP00942967Medicare PIN
FL0016180-00Medicaid