Provider Demographics
NPI:1659406585
Name:PARKE, JOHN C (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:PARKE
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 1:10337 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6287
Mailing Address - Country:US
Mailing Address - Phone:904-260-3200
Mailing Address - Fax:904-262-8205
Practice Address - Street 1:10337 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6287
Practice Address - Country:US
Practice Address - Phone:904-260-3200
Practice Address - Fax:904-262-8205
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4970YMedicare PIN