Provider Demographics
NPI:1467504720
Name:WHITMAN, JUDITH GAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:GAIL
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6195 LAKE GRAY BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5891
Mailing Address - Country:US
Mailing Address - Phone:904-389-1010
Mailing Address - Fax:904-389-1082
Practice Address - Street 1:2349 VILLAGE SQUARE PARK WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-389-1010
Practice Address - Fax:904-389-1082
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 3496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant