Provider Demographics
NPI:1689219446
Name:MILES, JORDAN ZEMIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:ZEMIS
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LINDSAY
Other - Last Name:ZEMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:850-390-4540
Mailing Address - Fax:
Practice Address - Street 1:23 MACK BAYOU LOOP
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-2606
Practice Address - Country:US
Practice Address - Phone:850-390-4540
Practice Address - Fax:850-390-4540
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105364300Medicaid