Provider Demographics
NPI:1639146905
Name:HABELL, DAVID FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:FRANCIS
Last Name:HABELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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 1:5460 BLANDING BLVD
Practice Address - Street 2:UFJP ANCHOR PLAZA FAMILY PRACTICE CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1957
Practice Address - Country:US
Practice Address - Phone:904-777-3019
Practice Address - Fax:904-777-1241
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002371AMedicaid
FL2907461-00Medicaid
FLE0623XMedicare PIN
FLE0623YMedicare PIN
FL2907461-00Medicaid
FLE0623ZMedicare PIN
FLE0623Medicare PIN