Provider Demographics
NPI:1588796742
Name:FIELDS, BOBBY (PA-C)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:FIELDS
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 1:815 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8412
Mailing Address - Country:US
Mailing Address - Phone:904-294-8689
Mailing Address - Fax:904-294-8689
Practice Address - Street 1:815 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8412
Practice Address - Country:US
Practice Address - Phone:904-294-8689
Practice Address - Fax:904-294-8689
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103014363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant