Provider Demographics
NPI:1558321430
Name:PABALATE, JONATHAN L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:L
Last Name:PABALATE
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIA DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4195
Practice Address - Fax:904-244-4908
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-01-07
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3358392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA331707142AMedicaid
FL3060675-00Medicaid
GA331707142DMedicaid
GA331707142CMedicaid
GA331707142AMedicaid
FLG3417ZMedicare PIN