Provider Demographics
NPI:1588033419
Name:PATRIDGE, HAYLEY GANT (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEY
Middle Name:GANT
Last Name:PATRIDGE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3627 UNIVERSITY BLVD S STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4294
Mailing Address - Country:US
Mailing Address - Phone:904-596-0760
Mailing Address - Fax:
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2593
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7420
Practice Address - Country:US
Practice Address - Phone:904-328-5289
Practice Address - Fax:904-328-1690
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2022-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109035363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant