Provider Demographics
NPI:1669498820
Name:INGERMANN, CRAIG ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANDREW
Last Name:INGERMANN
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 1:1824 KING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4736
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:5147 N 9TH AVE STE 318
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8710
Practice Address - Country:US
Practice Address - Phone:850-462-2250
Practice Address - Fax:850-741-3053
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106583363A00000X
IN10000710A363AS0400X
TNPA1556363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513206Medicaid
Q27871Medicare UPIN