Provider Demographics
NPI:1467535468
Name:NOTTINGHAM, ROBERT IRVING (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:IRVING
Last Name:NOTTINGHAM
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:125 DORNOCH CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3956
Mailing Address - Country:US
Mailing Address - Phone:904-273-1483
Mailing Address - Fax:904-285-5097
Practice Address - Street 1:1800 BARRS ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4704
Practice Address - Country:US
Practice Address - Phone:904-308-7340
Practice Address - Fax:904-308-2930
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA-1777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical