Provider Demographics
NPI:1538474176
Name:COWART, JACQUES E (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:E
Last Name:COWART
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 1:5453 GULF DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3903
Mailing Address - Country:US
Mailing Address - Phone:727-847-2214
Mailing Address - Fax:727-846-0923
Practice Address - Street 1:5453 GULF DR
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3903
Practice Address - Country:US
Practice Address - Phone:727-847-2214
Practice Address - Fax:727-846-0923
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical