Provider Demographics
NPI:1518135151
Name:PRESLEY, JASON BRETT (PA C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:BRETT
Last Name:PRESLEY
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 1:9085 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-943-1705
Mailing Address - Fax:
Practice Address - Street 1:5151 N 9TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5705
Practice Address - Country:US
Practice Address - Phone:850-857-1700
Practice Address - Fax:850-857-1746
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant